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Appellate Referral Form
*This form is for attorney-use only. If you are not an attorney, please contact us through the IDP hotline and we will assist you.
Please fill out form as completely as possible, as it will improve our ability to respond quickly and accurately.
Intake Received Via
Your First Name
Your Last Name*
Your Email
Your Phone
Organization
Client First Name
Client Last Name
Client Date of Birth
Client Country of Birth
Alien Number
Client Manner of Initial Entry
Manner of Entry (if Other)
Client Date of Initial Entry
Client Current Immigration Status
Current Immigration Status (if Other)
Date Received Current Immigration Status
Last Exit/Entry to U.S.
Immigration Status of Fiance/Spouse
Number of U.S. Citizen or LPR Children
State of Case
County of Case (NY State only)
Crim Trial Docket Number
Crim Trial Disposition
Statute/Subsection of Conviction
Offense Commission Date
Date of Plea
Date of Sentence
Sentence
Client Detention
Custody Location
Other Court & Conviction History
Basis and Posture of Appeal
Advisal Due Date

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