Expungement Questionnaire
Email *
Order number OR Arag Member ID number :
First Name * *
Last Name * *
Street Address * *
Address Line 2
City * *
State * *
Zip Code * *
Phone Number * *
Email Address * *
Drivers License State
Drivers License Number
Date of Birth * *
MM
/
DD
/
YYYY
Last 4 of social security number: * *
Case Number * *
Court house name and address
What were you charged with? *
Date of conviction
MM
/
DD
/
YYYY
Code name and section number of violation
Did you go to trial? *
Clear selection
Did you take a plea agreement/offer? * *
If you took a plea agreement, did you plea:
Column 1
Guilty
No Contest
I don't remember
Were you ordered to pay a fine or restitution? *
Clear selection
Were you placed on probation? *
Clear selection
Were you ordered to do jail or prison time? * *
Are you currently on probation or serving another sentence? *
Clear selection
Are you currently charged with another offense? * *
I acknowledge that no attorney/client relationship has been established solely by my filling out this questionnaire. I understand that an attorney/client relationship will ONLY be established upon my signing the attorney's retainer agreement and paying the applicable fees. *
Clear selection
Anything else we should know.....
Please make sure that you get a confirmation of submitting this form. If the form re-appears, you have not filled out all of the "required" sections. Do not leave this page until you have a confirmation of submission, or you will have to start all over.
A copy of your responses will be emailed to the address you provided.
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