Law Office of Richard Filiberto

35 Market Street 3d Floor
Poughkeepsie, NY 12601

845-474-7144

Traffic Ticket Intake

Please complete the intake form to allow my office to properly and efficiently assess your matter to determine if we can represent you regarding your traffic infraction matter.

The form includes basic contact information and specific details of your matter, including your driving history.

Prefix can be Mr. Ms. Dr. etc.

Some fields are required, indicated by a star

Contact information

Prefix

First name *

Middle name

Last name *

Emails

Address *

Type

Upon submission, a copy of this form will be sent to the primary email.

Add email

Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

Add address

Phone numbers

Phone number

Type

Add phone number

Today's Date

Date Summons Issued

Police Agency that issued the Summons

NYS Police

Local Police Department

Sheriff

Other

Number on Summons (upper left)

Charge on Summons

Court Summons is returnable to

Scan Ticket

Add attachment

Other correspondence from Court