Pierce COUNTY DRUG COURT

Attorney Referral

 

 

Offender Name: (Last) __________________ (First) ____________ (MI) __ 

Offender Current Address:  _______________________________________________

Phone Number: _____________________________________

           

Referral Date: ______________________  

 

Attorney Name and Phone Number: _______________________________________________

 

 

Alternate Address/Phone Number (if current address is jail): ______________________________________________________________________________

 

Offender Date of Birth: _______________________________

 

Does individual have outstanding warrant(s) or pending charge(s)?

 

Yes _____ No _____  If yes, explain: ______________________________________________

 

Current Offense(s)/Reason(s) For Referral:

 

 

 

Prior Offense(s) (Include if misdemeanor or felony) and Drug/Alcohol Use History:

 

 

 
Currently in AODA treatment?  Yes _____      No _____     If yes, where? ________________
 
Previously involved in AODA treatment?  Yes _____     No _____   
If yes, where/date(s) of attendance? _________________________________________________
_____________________________________________________________
Is individual presently on supervision?  Yes _____     No _____  
 
Any prior term(s) of probation supervision (juvenile/adult)?  Yes ____     No ___  

 

If yes, where/date(s)/offense(s) of supervision? _______________________________________

______________________________________________________________________________


 
Does individual have a valid driver’s license?  Yes _____     No _____   

 

If no, please specify: _____________________________________________________________

 

Is individual employed?  Yes _____     No _____     If yes, where? _______________________

 

Any prior convictions or assaultive/violent behavior or domestic abuse?  

 

Yes _____     No _____     If yes, please specify: _______________________________________

 

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