Pretrial Release Application Form

Pretrial Release Application Form
Apply for consideration of release prior to your court trial. Please complete all required sections accurately.
Applicant Full Name*
First NameLast Name
Date of Birth*
MonthDayYear
Date
Current Residential Address*
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Case Number*
Court Name or Location*
Charges Filed Against You*
Employed Full-TimeEmployed Part-TimeUnemployedStudentRetiredOther
Emergency or Character Reference Name*
First NameLast Name
Reference Relationship to Applicant*
Reference Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Reference Email Address
example@example.com
YesNo
If yes, please briefly describe your prior convictions (if any)
Should be Empty: