Psi Report Long Form

Presentence Investigation Form

Fill out completely and accurately. If you are unsure of an answer, estimate to the best of your knowledge and note that it is an estimate. All information will be verified and any discrepancies will be noted to the Court.
Defendant Information

Full (Legal) Name: ____________________________________________________________

_____

Alias or Nickname: ______________________ __________________________________________

Current Address: _____________________________________Phone:_______________________

City______________________________________State________Zip__

______________________

Permanent Address: ____________________________________________________________

___
(if different from above)

Date of Birth:____ /_____/_____ Social Security No.______________________________________

City & State of Birth_______________________________________________________

_________

Age______Race_____Sex____Height_______Weight_______Eyes_____

Hair_________________

ID Marks (inc. tattoos, scars) ________________________________________________________

____________________________________________________________

____________________

US Citizen_____Y______N Alien Status:______________________________________________

Driver’s License No. ____________________State of Issue________License Status_____________

Contact Persons

1. Name__________________________________Relation____________

Address___________________________________________________

Phone____________________________________________________

2. Name__________________________________Relation____________

Address___________________________________________________

Phone__________________________________________________
Please describe what you did to be arrested for this offense. This is your version of the offense and your statements will be directly quoted in this Pre-Sentence Report and will be submitted to the Court. You may also make any statements you wish in regard to your