Civil Rights & Personal Injury
Full Name:
Phone Number:
Email Address:
County of Residence:
Which Mississippi Justice Court were you convicted in?
What were you charged with?
(Examples: DUI, speeding, other misdemeanor)
Date of your citation:
Date you were told to appear (from your citation):
When did you find out about the conviction?
How did you find out?
(Check all that apply)
Was your license suspended?
– [ ] Yes
– [ ] No
– [ ] Unsure
Were you contacted by a collections agency?
– [ ] Yes
– [ ] No
If yes, what amount were they demanding?
Brief description of what happened to you:
Please send this completed form to:
Email: Chris@WeldyLawFirm.com
Phone: (601) 624-7460
Address: Weldy Law Firm, Jackson, Mississippi
A representative from Weldy Law Firm will contact you to discuss your case.
All information provided is confidential and will be used only to evaluate your potential case. This form is for informational purposes and does not constitute legal advice.
