TRAFFIC INTAKE FORM
Law Offices of Tina M. Barberi, PC
Contact Information
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Employment Information
Are You Employed (or Self Employed)?
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Identifying Information
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Charge Information
Current Charges:
Location Where You Received Ticket:
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Time of Ticket:
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Court Information
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Driving Record
Driving Record Points (5 years):
Driving Record Points (3 Years):
Are You a Commercial Truck Driver?
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Traffic School (Last 18 Month)?
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Other Pending Matters
Do You Have Other Cases Pending in Court?
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Do You Have Another Case Pending in Court?
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Prior Record
Do You Have Prior Traffic Tickets with Last 5 years?
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Prior Record:
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Do You Have Another Prior Case?
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Prior Record:
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Tell Us What Happened
Explain Circumstances of Traffic Charges & Any Defenses You May Have:
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Your Documents
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