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Appellate Referral Form, updated 8/20/18
Is this ILS?
Inquiry Stage
Intake Received Via
Your First Name
Your Last Name*
Your Email*
Your Phone Number
Client First Name
Client Last Name
Client Date of Birth
Client Country of Birth
Alien NumberThis is helpful to check the status of any removal proceedings.
Client Manner of Entry
Manner of Entry (if Other)
Client Date of Initial Entry
Client Current Immigration Status*
Date of Current Immigration Status
Conviction History
County of Case
Docket Number
Offense Commission Date
Crim Trial Disposition
Statute/Subsection of Conviction
Plea/conviction Date
Sentence Date
Upload a File

File(s) size limit is 20MB.

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