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Fill and Sign the Release Questionnaire Forms

Fill and Sign the Release Questionnaire Forms

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State of Alabama Unified Judicial System Form C-52(f) (front) Rev. 11/92 RELEASE QUESTIONNAIRE Case Number IN THE_______________________________________COURT OF __________________________________________, ALABAMA (Circuit, District or Municipal) (Name of County or Municipality) STATE OF ALABAMA MUNICIPALITY OF _____________________________ v.________________________________________ \ Defendant FOR THE PURPOSE OF DETERMINING CONDITIONS OF PRE-TRIAL RELEASE IN THIS CASE, THE COURT MAY TAKE INTO ACCOUNT THE FOLLOWING: 1. Where do you presently reside? ____________________________________________________________, How long have you lived at the address? ______________________________, If you have lived there less than one (1) year, where was your previous residence? ____________________________________________________\ _____________________, How long did you resi de at your previous residence? ______________________, 2. (a) Are you presently employed ________, If so, by whom? ____________________________________, What is the nature of your job?________________________________________________________, If you have been employed less than one (1) year, where were you previously employed? ____________________, ________________________________________ How long did you work there? ______________________, What was the reas on for your leaving? ______________________________________________________________,\ (b) What is your social security number? ______________________________________, (c) If you have not completed an Affidavit of Substantial Hardship, what is your approximate present net worth (value of all assets owned by you less all liabilities and debts owed by you) ? Assets of $ ________________ \ Minus Liabilities of $ ________ ________ \ Equals a Net Worth of $ ____________ ____ 3. (a) Are you married? ______________, Do you and your spouse live together ? ____________________, How long have you been m arried? ___________, Have you been married before? _____________, If so, how was the marriage ended? By ____________ _______(divorce or death). (b) Do you have children? _________, If so, how many and what are their ages? _______________________, Do they reside with you? ________, If not, list the names and addresses of liv\ ing children not residing with you. (If there are more names, please continue on an attached s eparate sheet of paper with the following information.) ______________________________________ ________\ ______________________________________________________ (Name) \ (Address) (Telephone Number) ______________________________________ ________\ ______________________________________________________ (Name) \ (Address) (Telephone Number) (c) Does any other member of your family reside in the same household? ___________________, Relationship: ________________________________________________\ __________________________________________________ (d) The names and address(es) of your nearest living relatives not resident with you: (If there are more names, please continue on an attached s eparate sheet of paper with the following information.) ______________________________________ ________\ ______________________________________________________ (Name) \ (Address) (Telephone Number\ ) ______________________________________ ________\ ______________________________________________________ (Name) \ (Address) (Telephone Number\ ) 4. Who in the community where you reside can vouch for your character, reputation, and reliability? ____________________________________________ _____________\ _________________________________________________ (Name) \ (Address) (Telephone Number\ ) ____________________________________________ _____________\ _________________________________________________ (Name) \ (Address) (Telephone Number) ____________________________________________ _____________\ _________________________________________________ (Name) \ (Address) (Telephone Number\ ) ____________________________________________ _____________\ _________________________________________________ (Name) \ (Address) (Telephone Number\ ) 5. Do you have any health problem? ______________________, If so, specify what problems. ________________________________________ ________________________________________________________________________\ __________________________________________ ________________________________________________________________________\ __________________________________________ Form C-52(f) (back) Rev. 11/92 RELEASE QUESTIONNAIRE 6. (a) Have you ever been arrested before? __________________, If so, indicate date, county, state, charge and disposition: DATE COUNTY STATE CHARGE DISPOSITION Are any of these cases pending? _____________, If so, lis t the charges and court(s) where pending: CHARGE COURT (b) H ________________________________________________________________________\ ______________________________________ ave you ever been released from a prior arrest on bail or on your personal recognizance? ________________, If so, list when and where. ________________________________________________________________________\ ______________________________________ ________________________________________________________________________\ ______________________________________ ________________________________________________________________________\ ___________________________________________ (c) ________________________________________________________________________\ ______________________________________ Have you ever been arrested for not appearing in court or ever had a bond or release revoked? _____________, If so, list wh en and where. ________________________________________________________________________\ ______________________________________ ________________________________________________________________________\ ______________________________________ (d) Do you presently owe any unpaid court costs, fines, assessments or restitution? ______________, If so, li\ st am ount(s) owed and the name of the court(s): AMOUNT COURT $ ___________________ $ ___________________ $ ___________________ $ ___________________ I HAVE BEEN ADVISED THAT CORRECT AND TRUTHFUL ANSWERS TO THE FOREGOING QUESTIONS ARE NECESSARY IN ORDER FOR THE COURT TO MAKE A DETERMINATION OF WHETHER TO GRANT MY RELEASE. I HAVE BEEN NOTIFIED THAT FALSE STATEMENTS ARE PUNISHABLE AS PERJURY. __________________________________ \ _______________________________________________ ________________ Date \ Defendant _______________________________________________________________ \ Social Security Number _______________________________________________________________ \ Address _______________________________________________________________ \ City State \ Zip Code \ _____________ ____________________________________ \ Telephone Number

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