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		CRIMINAL FORM Criminal Charge(s) Date of Offence(s) Address where you were arrested Time of Arrest Driver’s Licence Number Police Division Officer in Charge (If Known) Location of Court House Date of Next Appearance in Court Please provide details of your criminal record if you have a criminal record including any entries as a youth Did you a statement to the police when you were arrested? yes no Did you give a videotaped statement to the police when you were arrested? yes no Are there any co-accused in your case? {Here Rob – can you make a box across the screen like the box about the children and list name, charges and Name of Lawyer – No need for address of lawyer I will find that easily – just those categories} What is the make, model and year of your car? Do you rent or lease your vehicle? {Own or Lease} Please provide details of insurance. Did you give a breath sample to the police? yes no What time did you give the breath sample? How many minutes passed from the time you were stopped by the police and the time you gave the breath sample? Did you refuse to provide a breath sample? yes no Was anything seized at the time of your arrest? – yes no If something was seized, what was it? – Details If drugs were seized at the time of your arrest – do you know the weight of the drugs seized? What were you wearing at the time of your arrest? If there is an alleged victim in this case, please provide name, age and address of alleged victim if known to you. Were you taken to the hospital at the time of your arrest? yes no If so, what were your injuries and what hospital were you taken to? If there is an alleged victim, was this person taken to the hospital? yes no If the alleged victim was taken to the hospital, what were the injuries and what was the name of the hospital if known to you. What was the weather like at the time of your arrest? Please provide some additional background information about what the police say you did? Details. If this is a sexual assault case, do the police already have a sample of your DNA on file because it was provided in a previous criminal matter?     About Lance Carey Talbot | | Forms |