Case Evaluation Information EXPUNGEMENT

Transcription

1 Case Evaluation Information EXPUNGEMENT (Note: LEAAC may use some of the demographic, personal, and subjective information provided in this form to aggregate into anonymous data pools for our internal evaluation, analysis, and study of conviction and its social consequences. The results of those studies may be made public or used in LEAAC s legislative advocacy and lobbying efforts to make expungements more available, affordable, and effective. None of your personally-identifiable data will ever be shared or made public. By completing this form or by employing LEAAC to assist you in your case, you consent to your anonymous data being included in our research and analyses.) Date of Inquiry: / / Name of Person Making Inquiry: Full Legal Name of Arrested Person (if different from above): Legal name at the time of the arrest: Other aliases: Telephone number: (Home) ( ) - (Cell) ( ) - Address (physical): City: State: Zip code: Mailing address, if different: address: City: State: Zip code: Preferred method of contact (for documents): Telephone U.S. Mail DOB: / / SS#: - - Gender: M F O Race: Driver s License No: State: Number of children: Occupation: Marital status: Annual household income: Are you currently employed: Have you been denied any of the following because you have a criminal history: Employment Housing

2 Page 2 of 7 pages Insurance Custody Firearms Loans Friendship Trust Other Is someone going to assist you with the legal costs associated with this expungement: Yes No Why do you want an expungement? What do you view the benefit of expungement to be for you: Is there a deadline by which you feel you need an expungement, and what is that date, if any: Yes No Date: / /

3 Page 3 of 7 pages Do you have a copy of your criminal history, and, if so, from what database: Yes No Database Have you been informed by an employer, background check company or other entity that you have a criminal history, and, if so, (1) by whom were you informed, and (2) what were you told was on that history: Do you believe that the criminal history report is inaccurate, and, if so, how is it inaccurate: How did you locate LEAAC, and why did you select LEAAC to assist you: Prior Criminal History Information Incident #1

4 Page 4 of 7 pages Was Article 893 (for felony) utilized: Was Article 894 (for misdemeanor) utilized: Incident #2 How each charge was disposed of (dismissed, pleaded guilty, found guilty, acquitted, deal for lesser charge, etc.): Was Article 893 (for felony) utilized: Was Article 894 (for misdemeanor) utilized:

5 Page 5 of 7 pages Incident #3 How each charge was disposed of (dismissed, pleaded guilty, found guilty, acquitted, deal for lesser charge, etc.): Was Article 893 (for felony) utilized: Was Article 894 (for misdemeanor) utilized:

6 Page 6 of 7 pages Incident #4 How each charge was disposed of (dismissed, pleaded guilty, found guilty, acquitted, deal for lesser charge, etc.): Was Article 893 (for felony) utilized: Was Article 894 (for misdemeanor) utilized:

7 Page 7 of 7 pages At the time you agreed to resolve any of these cases, did you anticipate at that time getting the arrest / conviction removed by expungement later? Did your attorney explain to you that an expungement of the charge(s) may (or may not) be available at a later time, and what was your understanding, if any: How did you find out that you may be able to get an expungement: Do you have a restraining order or Title 46 (domestic abuse) Restraining Order in place against you? Yes No Don t Know Do you have any issues with crossing the boarder/immigration? If Yes, explain This form is strictly informational. No attorney client relationship (other than confidentiality) is established by submitting this form. LEAAC does not represent you until you have signed a representation agreement and paid the deposit and court cost. LEAAC does not undertake any responsibility for your case simply because you have completed this form. If you have any questions about your situation, you should contact LEAAC directly at