Prosecutors' Office
Request for Plea Offer Form
Date: November 22, 2014
Fields marked with an asterisk (*) indicate a required field.
Citation Number:
Cause Number:
*Defendant Name:
*Date of Birth (mm/dd/yyyy):
*Driver License Number:
*Driver License State:
*Driver License Type:
*Is the Driver License a CDL?:
*Date of Offense (mm/dd/yyyy):
Offense/Incident Location:
Name of Officer:
Offense/Violation:
*Requestor Name:
*Requestor Relationship to Defendant:
*Represent by Attorney:
*Attorney Name:
*Attorney State Bar Number:
*Attorney Address:
*Attorney City:
*Attorney State:
*Attorney Zip Code:
*Attorney Phone Number: