Traffic New Client Intake
Full Name (First Middle Last)
Date of Birth
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Present Street Address (Street, City, State, and Zip)
Telephone Number
Email Address
Current Employer Name
Employer's Address (Street, City, State, and Zip
Employer's Phone Number
Jurisdiction of Charge (City, County, State)
Case Number (If Known)
Next Scheduled Court Date
MM
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DD
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YYYY
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