Hunt Law Firm - The Lake Charles, Louisiana DWI, Bankruptcy and Injury Attorney

Expungement Intake Form

DISCLAIMER: Submitting this form does not create an attorney/client relationship

All data should be entered in Mixed Case.

Personal Information

Full Name:

Date of Birth:

Driver's License #:

	Driver's License State:

Gender:

	Race:		SSN:

Current Address:

	Apartment #

City:

	State:		Zip Code:

County/Parish:

	If Other:

Email Address:

Phone Numbers

     - please enter your:
         Home Number, Cell Phone Number, Fax Number,
         any other Phone Numbers at which you can be reached
     - phone numbers must be in xxx-xxx-xxxx format
     - if adding a Cell Phone, please enter you Cell Phone Company and if your phone accepts text

Type	Phone Number	Extension/Notes	Cell Phone Company	Accepts Text

Arrest Information

What charges are seeking to get expunged?

Did your charges result in an actual arrest?
If yes, who was the arresting authority?
What year were you arrested and/or charged?
Where you actually convicted of the charge(s)?
In what parish did the arrest or conviction occur?

If Calcasieu, where were the charges brought?
(District attorney, LC City, Sulphur City Court, other) Please explain.

Do you have any previous arrests?

If yes, when, where and for what?

Do you have any previous convictions?

If yes, when, where and for what?

Security Code:

Enter Security Code: