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Takakjian, Sowers & Sitkoff, LLP

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or fill out our Online Questionnaire below.

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(888) 579-4844

 

Online Questionnaire

In order to best serve you, it is extremely important for Takakjian, Sowers & Sitkoff LLP to obtain the following information about a prospective client. We have a very strict PRIVACY POLICY. Whether or not you choose to retain our firm, this information is STRICTLY CONFIDENTIAL and will not be divulged. It is solely for your attorney's use. *IF YOU WOULD PREFER NOT TO COMPLETE THE FOLLOWING QUESTIONNAIRE AND SIMPLY SEND US AN EMAIL, PLEASE CLICK HERE. By completing this form you will be sending the information to our law firm. We will contact you as soon as possible.

If you decide you do not wish to complete this form, please click the back button and return to the website.

* NOTE: Your name and email address are required at the end of this form.


THE FOLLOWING INFORMATION IS REQUESTED ABOUT THE PERSON ARRESTED, CHARGED OR UNDER INVESTIGATION (Please answer as many questions as possible).
WE WILL RESPOND TO YOU TODAY!


Mr.    Mrs.    Ms.    Juvenile   

First Name:

Middle Name:

Last Name:

Nicknames/ a.k.a. 's:

Date of birth:

 month       day       year      

U.S. Citizen:
Yes    No   

(If you are not an U.S. citizen, there may be significant Immigration consequences to a criminal conviction).

Social Security #:

Driver License #:

State where licensed:

Home Street Address:

Apt. or Suite #:

City:

State:

Country:

ZIP:

Home Phone #:



   Is it okay to call? Yes    No   

Cell Phone:



   Is it okay to call? Yes    No   

Pager #:

Fax #:

Alternate Phone #:

Home Email:

Name of nearest relative:

Relationship to you:

Their Home Street Address:

Apt. or Suite #:

City:

State:

Country:

ZIP:

Their Home Phone #:

Employer:

What is your job title?:

Your Work Street Address:

Suite / Office #:

City:

State:

Country:

ZIP:

Work Phone #:

  Extension #:  

  Is it okay to call? Yes    No   

Work Email:

Was your vehicle impounded?
Yes    No   

If so, has your vehicle been returned to you?
Yes    No   

Please describe your vehicle or the vehicle you were driving:

Year

Make (e.g. Chevy, Ford, Toyota, BMW etc.)

Model (Malibu, Taurus, etc.)

Type of vehicle (car, truck, van, SUV etc.)

Color:

ARREST INFORMATION


Have you been arrested?
Yes    No   

If you have not been arrested, do you feel that you may be under investigation?

Yes    No   

If you may be under investigation, what offense do you think you may be accused of committing? (e.g. theft, assault, sex crime, white collar/ Federal Offense etc.)

Please give us some details of the incident:

If you were arrested, please provide us the following information:

Name used when you were arrested:

Date of Arrest:

What were you arrested for? (Please list all charges)

Bail Amount: $  

Has bail been posted?
Yes    No   

Type of bail that was posted:

Surety Bond

    (The most common bail bond, where assets are pledged)

Property Bond

    (A lien on property by the court)

Cash Bail

    (Cash is deposited in the amount of the bail)

Citation Release

   (A written citation is given at the time of release from custody)

Own Recognizance

   (An "O.R." release is ordered by the judge at the first court appearance)

Arresting Agency:

Name of Arresting Officer:

Officer's Badge or ID #:

Your Booking Number:

City (Where you were arrested):

Name of Court (Where you are to appear):

 

Note: we may be able to appear on your behalf!

Next Court Date:

Was anyone else arrested with you (Co-Defendants)?
Yes    No   

If so, what are their names?

Please give us details of why you were arrested (The information you provide will be kept confidential and can not be disclosed).

Do you have more than one case currently pending?
Yes    No   

Please give us details of any other pending cases:

Do you have any prior convictions?
Felony    Misdemeanor    Juvenile   

If so, when and where were you convicted? ("Date" Please list the date of the conviction), ("Location" Please list the city and state of the court where you ere convicted) and ("Offense" Please list the crime for which you were convicted). Please include any juvenile offenses:

Date:

Location(Court):

Prior Offense:

Are you currently on probation?
Yes    No   

Are you currently on parole?
Yes    No   

For what offense are you on probation or parole?

When does your probation or parole expire?
Date:    month      day      year       

Have you ever failed to appear in court for any criminal matter, including minor or traffic offenses?
Yes    No   

If so, please give us the details:

Date:

Location(Court):

Offense:

Do you have any outstanding warrants (including traffic warrants)?
Yes    No   

Details:

If you do not mind, please tell us where you found our website?
West / Findlaw Legal Directory (Lawoffice.com)
Martindale-Hubble Legal Directory (Lawyers.com)
Verizon Superpages Directory (SuperPages.com)
GoTo Search Engine (GoTo.com)
AOL Search (AOL.com)
Yahoo! Search (Yahoo.com)
Other (Please indicate):


Are you completing this form on behalf of someone else?
Yes    No   

If "Yes", please give us your contact information:

Your First Name:

Your Last Name:

Your Phone #:

Your Email:

Your Relationship to the person arrested:


Click here to go to the end of the form and send us the above information

* HOWEVER, if you were arrested for drunk driving or dui, please also complete the following dui questionnaire first and then click at the bottom of the form


DRUNK DRIVING - DUI QUESTIONNAIRE


Name of person arrested:  

Where were you coming from prior to the traffic stop or accident? (restaurant, bar, home, etc.)

How long had you been driving just prior to the stop or accident?

What time was it when were you stopped or involved in an accident?

When did you consume your first drink that day?

When did you finish your last drink that day?

*How many drinks did you have?
(One drink is a 12 oz. beer, 4 oz. of wine, a "shot" or mixed drink with only 1¼ oz. of 80 proof liquor)

Gender:
Male    Female   

What is your height?      
What is your weight?  

Was any alcohol consumed after you were driving? (e.g. Using a breath spray as the officer approaches, returning home after an accident and consuming alcohol, etc.).

Was any food consumed within 8 hours of the traffic stop/accident?
Yes    No   

What time was it and what did you have to eat before the incident?

How many hours of sleep did you get the night before?  

If you were stopped by a police officer, what was the reason given for the stop?

Was your vehicle impounded?
Yes   No        
If so, has your vehicle been returned to you?
Yes   No   

Please describe your vehicle or the vehicle you were driving:

Year

Make (e.g. Chevy, Ford, Toyota, BMW etc.)

Model (Malibu, Taurus, etc.)

Type of vehicle (car, truck, van, SUV etc.)

Color:

If you were involved in a traffic accident was anyone injured?
Yes    No   

If so, please describe:

Were you taking any medications or drugs at the time?
Yes    No   

If so, what drugs/medications were you taking and how much?

Were passengers in your vehicle?
Yes    No   

If so, how many?

What were their names?

Was there a child in the vehicle?
Yes    No   

(A person convicted for DUI with a child under the age of 14 in the vehicle is subject to a mandatory 48 continuous hours in jail. 23572 CVC).

Prior to being stopped/accident, could you have been speeding more than +20 mph over the speed limit on a street or +30 mph over the speed limit on a freeway?
Yes    No   

(A person convicted for DUI found to be driving recklessly and at an excessive speed is subject to an additional consecutive 60 days in jail! 23582 CVC).

Did you have a valid Driver License at the time?
Yes    No   

Did the officer take your license?
Yes    No   

Did the officer give you a Temporary Driver License and a "Notice" to contact DMV?
Yes    No   

IMPORTANT !! PLEASE NOTE !! DMV must be contacted within 10 days of your arrest to request a hearing to stop your AUTOMATIC DRIVER LICENSE SUSPENSION !! We can make this request for you. If the 10 days is about to expire, please call us immediately at (888) 579-4844.

Did you perform some field sobriety tests "F.S.T.'s"?
Yes    No   

Please check each that apply:

Horizontal Gaze Nystagmus - HGN (Stand keeping head still, follow a finger or pen with your eyes).

Modified Position of Attention - Rhomberg (Stand both feet together, arms at side, head tilted back, eyes closed and estimate 30 seconds).

Leg Raise - (Stand with feet together, arms at side raise one foot approximately six inches off ground).

Finger Count - (Touching tip of your fingers to the tip of your thumb).

Hand Pat - (Patting the palm and back of your hand).

Finger to Nose - (Standing at attention, head tilted back, eyes closed, touching the tip of your index finger to the tip of your nose).

Walk the Line - (Walking heel to toe several steps, turn around and walk back heel to toe).

Reciting the Alphabet

Counting

Other, please describe:

Were you injured or do you have any previous injuries/illnesses or limiting physical disabilities? (Eg. bad back or knees, inner ear infection, epilepsy, diabetes, poor balance, etc.) that would have possibly affected how you performed on the FST's (balance and co-ordination tests.)
Yes    No   

If so, please describe:

Prior to being arrested and taken to the station, did the officer have you blow in to a hand-held breath tester (Preliminary Alcohol Screening- PAS/PBT device) at the traffic stop/accident scene?
Yes    No   

Do you know your breath alcohol reading(s)?
Yes    No   

Did the officer tell you that the PAS test was voluntary?
Yes    No   

If so, what were your readings (The officer might say something like: "point-oh-eight" or .08, .14 or .22%, etc.):
My readings were (in the field):      (at the station): 

After you were arrested, were you advised that you had a choice of taking either a blood or breath chemical test to determine the alcohol content of your blood?
Yes    No   

Which test did you take:  
Blood       Breath      Urine      I refused to take a test

If you refused to take a chemical test, did the officer advise you that you could loose your license for a minimum of one year?
Yes    No   

A person convicted of DUI and Refusing to take a chemical test faces additional mandatory jail time

If you know the results of the "Chemical Test", what was your blood alcohol level?    %

(A Blood Alcohol Concentration - "BAC" over a 0.20% may result in increased court penalties).

How much time elapsed from the time you were arrested (handcuffed) until the time that you took the chemical test? (Like blowing into the machine at the station or having your blood drawn.)  

Do you have any medical condition(s) or dental work that could trap food particles in your mouth or that could have caused you to burp or regurgitate (e.g. GERD -Gastro-Esophogeal Reflux Disorder) within the 15 minutes prior to your giving a breath sample?
Yes    No   

(Note: If you burped or regurgitated within the 15 minutes immediately prior to a breath test, the machine may have given an erroneously high reading).

Details:

Did the officer read you your Miranda Rights (Right to Remain Silent)?
Yes    No   

Did you "waive" or give up your rights and agree to speak to the officer?
Yes    No   

Did you answer the officer's questions?
Yes    No   

Have you had previous DUI/DWI convictions?
Yes    No   

If so, please name the State and give us the approximate date of arrest or date of conviction, Court and charge(s) for each prior DUI conviction.

Date:

Location(Court):

Prior Offense (Charge):

Do you have some other comments to share with us before we contact you?

(Required) Full Name:

(Required) Email Address:

Send me an email at:

Call me at my home phone number:

Call me at my work phone number:

Call me on my cell phone:

Contact me at the following:

The best time to contact me:

* Anti-spam question:

The use of the Internet for communications with the firm will not establish an attorney-client relationship and messages containing confidential or time-sensitive information should not be sent.

      

We are quite successful in retaining our client's driver license and defending our clients in court. If you would prefer to not send us this form then please do not hesitate to contact us for a
FREE CONSULTATION at (888) 579-4844

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An attorney client relationship is not established by submitting this initial contact information to our office.

Southern California Criminal Defense Lawyer Disclaimer: The california criminal defense, dui, drunk driving, felony, misdemeanor or other california legal information presented at this site should not be construed to be formal legal advice, nor the formation of a lawyer or attorney client relationship. Any results set forth here were dependent on the facts of that case and the results will differ from case to case. Please contact a Los Angeles Criminal Defense attorneys or lawyers at one of our Southern California law firm offices located in throughout Southern California. This web site is not intended to solicit clients for matters outside of the State of California.

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