Middle Georgia Justice - Intake Request Form

**** IF YOU NEED CRIMINAL HISTORY RELIEF OR EXPUNGEMENT OF RECORDS, CLICK THIS LINK: https://docs.google.com/forms/d/e/1FAIpQLSf4hrxlnoUcOOHEYmjTfW68P7qiPs9X31yk9O9LkjjIpahjVA/viewform 

**** DO NOT FILL OUT MORE THAN ONE FORM PLEASE!

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Email *
First Name *
Last Name *
Date of Birth *
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DD
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YYYY
Phone Number
 *
What is your legal issue?
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Please explain your legal issue in further detail. 
County of Legal Issue *
Does your legal issue involve domestic violence? *
Your MONTHLY gross income (Before Taxes) *
How many people are in your household? *
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