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Client Information(Client = person who has an immigration problem because of a criminal case)










Client’s Current Criminal and Immigration Situation
 Not in Custody In Criminal Custody? In Immigration Custody?

 No Yes

 No Yes
 No Yes




 Undocumented Work Permit* Holder Visa Holder
 Yes

 No Yes

 Yes
 No Yes
 No Yes
 No Yes
 No Yes
 No Yes
 No Yes




 No Yes





Criminal History Summary
FIRST CONVICTION* (If you have more than one conviction, start with the oldest and end with the most recent.)



 Municipal Court Superior Court Federal Court Other Court

 Guilty Plea PTI or Conditional Discharge Convicted by Trial Jury Trial Court Trial










 No Yes
 No Yes

SECOND CONVICTION*



 Municipal Court Superior Court Federal Court Other Court

 Guilty Plea PTI or Conditional Discharge Convicted by Trial Jury Trial Court Trial










 No Yes
 No Yes

THIRD CONVICTION*



 Municipal Court Superior Court Federal Court Other Court

 Guilty Plea PTI or Conditional Discharge Convicted by Trial Jury Trial Court Trial










 No Yes
 No Yes
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Intake Information Sheet

Thank you for your interest in our services.

Please provide information so we can evaluate your situation, and see whether we can help.

If you do not understand certain words or questions, look at the glossary on the last page of this form. All words marked with an * are defined in the glossary. If you still need help, contact our office at (201) 703-9400.

If you do not remember your criminal history information, or need help getting the documents listed below, for a fee we can help you get the necessary information.

If you need more space to answer a question completely, please use a separate page.

Please make additional copies of the Conviction Information Sheet (Page # 4), if necessary, to include information on every one of your criminal cases.

We will not release any information you provide to anyone without your permission.

For EACH criminal case, please send copies of the following documents, if available:

  1. The charging paper (i.e., complaint, information, etc.)
  2. The police report
  3. The state and/or FBI rap sheet or criminal history report
  4. If you have already been convicted or have pleaded guilty or no contest, please also send:
  5. The docket or clerk’s minutes from the plea and sentence
  6. The reporter’s transcript of the plea and sentence
  7. Any waiver of rights form signed by the defendant, and
  8. The probation report

Once you have completed the Intake Form, submit it to us over the internet, fax it to us at (201) 703-9430, or mail it to us at: 0-100 27th Street, Fair Lawn, NJ 07410.

Consultation: We will review the form without charge. If we recommend a consultation, we will contact you to schedule an appointment. A consultation in person at our office or by telephone is up to 1½ hours, as necessary. We cannot conduct a consultation without an appointment.

For further information on our office, the services we offer, the immigration consequences of criminal cases, and how to clear NJ convictions from your records, visit our website: www.njcrimmigration.com