<p> THE PECK LAW OFFICE</p><p>Defense Client Intake – Case Information</p><p>PART I: GENERAL INFORMATION</p><p>To be filled in by client:</p><p>Your name:______Date:______</p><p>Client Name (If same as above, indicate “same”______</p><p>Client DOB: ______Client Social Security Number______</p><p>Client Address______City:______Zip______</p><p>Client Phone______Client Email ______</p><p>Charge(s)______</p><p>Facts Known, if any:______</p><p>COUNTY/COURT: [ ] Hamilton [ ] Common Pleas [ ] Municipal [ ] Mayor’s Court ______[ ] Butler [ ] Common Pleas [ ] Municipal ______[ ]Area ______[ ] Clermont [ ] Common Pleas [ ] Municipal [ ] Warren [ ] Common Pleas [ ] Municipal [ ] Lebanon Municipal [ ] Montgomery [ ] Common Pleas [ ] Municipal [ ] Western [ ] Eastern [ ] OTHER: ______</p><p>DATE OF ARREST: ______</p><p>Is he or she in Jail? [ ] Yes [ ] No If Yes, which Jail? [ ] Justice Center, Hamilton County [ [ Butler County Hanover St. [ ] Butler County Court St. [ ] Warren - Justice Drive [ ] Clermont County [ ] Montgomery County</p><p>RELEASE DATE: ______If still in Jail, Bond is set at $ ______</p><p>POSSIBLE MITIGATION ISSUES</p><p>To Be Filled In By Client</p><p>EMPLOYMENT [ ] Yes [ ] No If Yes, please indicate place employment______Length of time at this Employment:______If incarcerated, is employment still available? [ ] Yes [ ] No How do you know this?______EDUCATION [ ] Some High School [ ] GED [ ] Tech or Trade School [ ] Some College [ ] College Grad [ ] Grad School Last School Attended ______Did you graduate? [ ] Yes [ ] No </p><p>SUBSTANCE ABUSE: [ ] Alcohol [ ] Crack [ ] Cocaine [ ] Heroin [ ] Meth. Amphetemines [ ] Marijuana [ ] Methodone [ ] Pills: – Prescribed [ ] Yes [ ] No. List other substances: ______Prior Treatment [ ] Yes. [ ] No. Details: ______MENTAL HEALTH: Diagnosed [ ] Yes. [ ] No. Diagnosis: ______Who? ______When ______Suspected? ______Services Agency: ______Contact: ______Phone ______[ ] Case worker [ ] Counselor [ ] Psychiatrist TREATMENT: Does the client appear to be eligible for: [ ] intervention in lieu [ ] Drug Court [ ] SAMI Have you completed application form with client [ ] Yes. [ ] No. Filed [ ] Yes. [ ] No. GENERAL MITIGATION: ______PART II ARREST INFORMATION</p><p>To Be Completed By Attorney</p><p>AGENCY: [ ] Sheriff ______County [ ] Cincinnati Police Department [ ] ______[ ] Hamilton [ ] Middletown [ ] Fairfield [ ] West Chester [ ] Oxford [ ] Highway Patrol</p><p>PRIMARY OFFICER ______OTHERS ______, ______, ______</p><p>INCIDENT REPORT NO(s): ______, ______, ______, ______Are these reports attached? [ ] Yes [ ] No. Why not? ______</p><p>IF OVI, copies attached: (1) Breath or blood test: [ ] Yes, [ ] No; (2) Refusal; [ ] Yes, [ ] No; (3) ALS: [ ] Yes, [ ] No.</p><p>SFST______</p><p>CHARGES: DEGREE: BOND AMT BOND TYPE BOND POSTED: DATE POSTED: ______[ ] Yes [ ] No ______[ ] Yes [ ] No ______[ ] Yes [ ] No ______[ ] Yes [ ] No ______In lieu of recaptulation above, I have attached a [ ] Docket sheet or [ ] Copies of complaint attached, with bond notes WAS PRELIMINARY HEARING HELD? [ ] Yes – date ______. [ ] No. CO-DEFENDANTS? Name: ______Attorney: ______Charged: [ ] Yes [ ] No. Name: ______Attorney: ______Charged: [ ] Yes [ ] No. Name: ______Attorney: ______Charged: [ ] Yes [ ] No. STATE’S WITNESSES: Name: ______, Address: ______Phone: ______Testified [ ] Yes [ ] No. Name: ______, Address: ______Phone: ______Testified [ ] Yes [ ] No. Name: ______, Address: ______Phone: ______Testified [ ] Yes [ ] No. POSSIBLE DEFENSE WITNESSES: Name: ______, Address: ______Phone: ______Notes:______Name: ______, Address: ______Phone: ______Notes:______Name: ______, Address: ______Phone: ______Notes:______</p><p>PART III: POTENTIAL ISSUES:</p><p>Translator? [ ] Yes, [ ] No. ASL Signer? [ ] Yes, [ ] No. Other accomodations? [ ] Yes, [ ] No. Details: ______Client statements: [ ] Oral [ ] Audio [ ] Video [ ] Written – is copy attached? [ ] Yes. [ ] No. Substance, if not attached but known: ______Witness statements: [ ] Oral [ ] Audio [ ] Video [ ] Written – is copy attached? [ ] Yes. [ ] No. Substance, if not attached but known: ______Competency? [ ] Yes [ ] No. If so, why? ______NGRI? [ ] Yes [ ] No. If so, why? ______Suppression? [ ] Yes [ ] No. Check applicable: [ ] Stop [ ] Detention [ ] Arrest [ ] Possible grounds: ______Warrant? [ ] Yes [ ] No . Is a copy attached? [ ] Yes [ ] No. Common Pleas No. IR ______Searched: [ ] Person, [ ] Car, [ ] House, [ ] Cell phone, [ ] Computer, [ ] Closed container: ______, [ ] Other: ______What was the articulated cause of the search warrant? ______If no warrant, search claimed to be incident to… [ ] Arrest, [ ] Traffic Stop, [ ] Consent, [ ] Plain view, [ ] Inventory, [ ] Emergency Applicable details: ______Identification? General? [ ] Yes [ ] No. If yes: Show up? [ ] Line-up? [ ] Photo-line up? [ ] Did the witness give pre-arrest descriptions to… [ ] officer? [ ] 911? [ ] 3rd party? BOLO? [ ] Yes [ ] No. [ ] Gender? [ ] Age? [ ] Race? [ ] Height? [ ] Weight? [ ] Build? [ ] Tattoos? [ ] Clothing? [ ] Eye color? [ ] Hair color? [ ] Hair length? [ ] Facial hair? [ ] Voice – deep/high, soft/loud, lisp? Did the witness describe only after observe the defendant in the courtroom? [ ] Yes [ ] No. Possible discrepencies/obstructed views/corruptions by 3rd parties:______Gut opinion: [ ] No bill [ ] Certified back [ ] Plea with mitigation [ ] Trial [ ] Treatment Why: ______Danger, danger: [ ] added charges? [ ] enhancement of felony level? [ ] specifications? Why: ______TPO in effect? [ ] Yes. [ ] No. Protected persons: ______</p>