IN THE_______________________________________COURT OF __________________________________________, ALABAMA  
                                               (Circuit,  District or Municipal)                                                                             (Name of County or Municipality) 

(cid:0) STATE OF ALABAMA 
(cid:0) MUNICIPALITY OF_____________________________ v.________________________________________ 
                                                                                                                                                               Defendant 
 

RELEASE QUESTIONNAIRE 

Case Number 

orm C-52(f) (front)      Rev. 11/92 

  F

 

State of Alabama 
Unified Judicial System 

FOR THE PURPOSE OF DETERMINING CONDITIONS OF PRE-TRIAL RELEASE IN THIS CASE, 
THE COURT MAY TAKE INTO ACCOUNT THE FOLLOWING: 

1.  Where do you presently reside? ____________________________________________________________, 
        How long have you lived at the address? ______________________________, If you have lived there less than one (1) year, where was your      

previous residence? _________________________________________________________________________, 

        How long did you reside at your previous residence? ______________________, 
2. 
(a)    Are you presently employed ________, If so, by whom? ____________________________________, 
                What is the nature of your job?________________________________________________________, 
                If you have been employed less than one (1) year, where were you previously employed? ____________________, 
                ________________________________________ How long did you work there? ______________________, What was the reason for your      
               leaving? ______________________________________________________________, 

(b)  What is your social security number? ______________________________________, 

(c) 

If you have not completed an Affidavit of Substantial  Hardship, what is your approximate present net worth (value of all assets owned by you less     

all liabilities and debts owed by you) ?                      Assets of                            $ ________________ 

                                                                                     Minus Liabilities of            $ ________________ 

                                                                                     Equals a Net Worth of       $ ________________                            

3. 
(a)     Are you married? ______________, Do you and your spouse  live together ? ____________________, How long have you been married?    
                  ___________, Have you been married before? _____________, If so, how was the marriage ended?  By ___________________(divorce    
                  or death). 

(b)     Do you have children? _________, If so, how many and what are their ages? _______________________, Do they reside with you? 

                   ________, If not, list the names and addresses of living children not residing with you. 

          (If there are more names, please continue on an attached separate sheet of paper with the following information.) 

           ______________________________________               ______________________________________________________________ 
           (Name)                                                                                           (Address)                                                     (Telephone Number) 
           ______________________________________               ______________________________________________________________ 
           (Name)                                                                                           (Address)                                                     (Telephone Number) 
 (c)     Does  any  other  member  of  your  family reside in the same household? ___________________, 

          Relationship: __________________________________________________________________________________________________ 

(d)  The names and address(es) of your nearest living relatives not resident with you: 

(If there are more names, please continue on an attached separate sheet of paper with the following information.) 

           ______________________________________               ______________________________________________________________ 
           (Name)                                                                                (Address)                                                                           (Telephone Number) 

           ______________________________________               ______________________________________________________________ 
           (Name)                                                                                (Address)                                                                           (Telephone Number) 

4.  Who in the community where you reside can vouch for your character, reputation, and reliability? 

____________________________________________               ______________________________________________________________ 
(Name)                                                                                           (Address)                                                                           (Telephone Number) 
____________________________________________               ______________________________________________________________ 
(Name)                                                                                         (Address)                                                                           (Telephone Number) 
____________________________________________               ______________________________________________________________ 
(Name)                                                                                           (Address)                                                                           (Telephone Number) 
____________________________________________               ______________________________________________________________ 
(Name)                                                                                           (Address)                                                                           (Telephone Number) 
5.  Do you have any health problem? ______________________, If so, specify what problems. ________________________________________ 

__________________________________________________________________________________________________________________ 

__________________________________________________________________________________________________________________ 

 

 

orm C-52(f) (back)      Rev. 11/92 

RELEASE QUESTIONNAIRE 

6.        (a)   Have you ever been arrested before? __________________, If so, indicate date, county, state, charge and disposition: 

DATE 

COUNTY 
 

STATE 
 

CHARGE 
 

DISPOSITION 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CHARGE 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COURT 
 

 

 

 

COURT 

 

 

 

 

               
              Are any of these cases pending? _____________, If so, list the charges and court(s) where pending:  

          
ave you ever been released from a prior arrest on bail or on your personal recognizance? ________________, If so, list when and where.    
         (b)     H
               ______________________________________________________________________________________________________________ 
               ______________________________________________________________________________________________________________ 
               ______________________________________________________________________________________________________________ 

       ___________________________________________________________________________________________________________________ 

(c) 

Have you ever been arrested for not appearing in court or ever had a bond or release revoked? _____________, If so, list when and where. 
              ______________________________________________________________________________________________________________ 
              ______________________________________________________________________________________________________________ 
              ______________________________________________________________________________________________________________ 
  
          (d)    Do you presently owe any unpaid court costs, fines, assessments or restitution? ______________, If so, list amount(s) owed and the name  
                   of the court(s):   

AMOUNT 
$ ___________________ 

$ ___________________ 

$ ___________________ 

$ ___________________ 

 

 

  HAVE  BEEN  ADVISED  THAT  CORRECT  AND  TRUTHFUL  ANSWERS  TO  THE  FOREGOING  QUESTIONS  ARE  NECESSARY  IN  ORDER  FOR  THE  
COURT  TO  MAKE  A  DETERMINATION  OF  WHETHER  TO  GRANT  MY  RELEASE.    I  HAVE  BEEN  NOTIFIED  THAT  FALSE  STATEMENTS  ARE 
PUNISHABLE AS PERJURY. 

__________________________________                                              _______________________________________________________________ 
Date                                                                                                          Defendant 

_______________________________________________________________ 

                                                                                                                  Social Security Number 

                                                                                                                  Address 

_______________________________________________________________ 
                                                                                                                  City                                                       State                                          Zip Code 
                                                                                                                  _________________________________________________ 
                                                                                                                  Telephone Number  
 

_______________________________________________________________ 

    F

 

   

 

  I