Drug Treatment Court Participant Referral Form
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Defendant Name:

 

 

Address:

 

 

Home Phone Number

 

Cell Number

 

 

 

Gallery Number

 

Current Charge

 

Cause Number/ Agency Case Number

 

Person Making Referral

 

 

Agency

 

Address

 

Phone Number

 

E-mail

 

Comments

 

 

Please attach the probable cause affidavit, charging information and criminal history and or agency report and submit to:

Jennifer Fillmore Program Coordinator via e-mail jfillmor@indygov.org, fax 317-327-4920 or mail to 251 East Ohio St. Suite 850, Indianapolis, IN  46204.