NJ Municipal Court and Criminal Interview sheet
PLEASE PRINT OUT SHEET, FILL OUT ALL PAGES OF OUR CONFIDENTIAL INTERVIEW
FORM AND Fax [not email] to
KENNETH VERCAMMEN & ASSOCIATES, PC
ATTORNEY AT LAW
2053 Woodbridge Ave.
EDISON, NJ 08817
732-572-0500
fax 732-572-0030
PLEASE PRINT
NAME _______________________________________________
ADDRESS _____________________________________________
CITY _______________________ STATE ____
ZIP ______________
PHONE-DAY (____)_____________
DAY/CELL (____)_____________
NIGHT(____)________________
TODAY'S DATE ____/_____/_____
E-MAIL ________________________
Referred By: ___________________________________
CHARGES/TICKETS ISSUED [provide tickets, hearing notice and other important
papers to front desk to be copied]
1. _________________________________________________
2. _________________________________________________
3. _________________________________________________
4. _________________________________________________
IMPORTANT INFORMATION
Date of Offense: ____________ Time: __________(A.M./P.M.)
Your Age _________
Town: ___________________________
(street/location)?____________________
What Happened: ________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
Other Persons Arrested or Witnesses:
______________________ ____________________________
co-defendant/ Witness Name Their Address Phone No.
______________ ______________________________________
Name Address Phone No.
What statements did you give to the police?
______________________________________________________
______________________________________________________
Occupation: _____________ Employer: _______________
Town: ________
Do you need your drivers license for work? ____
Distance driven to work: ____
Prior criminal convictions (include description of each charge, date of
conviction, and place of conviction):
______________________________________________________
______________________________________________________
______________________________________________________
Prior motor vehicle convictions, town and year(ex: drunk driving, no
insurance, driving while suspended, etc.):
____________________________________
______________________________________________________
______________________________________________________
______________________________________________________
Prior Traffic ticket downgrades to no point tickets since 1999 [39:4-97.2]:
1. Town _______________________ Year ___________
2. Town _______________________ Year ___________
[Please note the traffic law only permits 2 "no point" downgrades in 5
years.]
What questions do you have/ how can we help you and anything else important:
________________________________________________
______________________________________________________
___________________________________________________ New clients: Would you
like a Free Cup __, Visor ___, Pen, __ Foam can holder ___, Comb __,
Calendar __, Magnet __.
All new clients are entitled to receive our Free Email Newsletter
featuring updates in Traffic Law, Criminal and Personal Injury. Thank you.
