Bail Assistance Request Form BAIL ASSISTANCE REQUEST FORM: Name First Last Email Address Phone Number Are you a Public Defender or Paralegal? — Select — Public Defender Paralegal Other What Lawfirm or Division are you with? Case Number Charges Jurisdiction Name of Person Needing Bail Email Address of Person Needing Bail Date of Birth of Person Needing Bail Bail Amount ($0.00) Jail Person is Being Held In