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Offices by Appointment

10480 Little Patuxent Parkway
Suite 400
Columbia, Maryland 21044

Mailing Address

Post Office Box 694
Columbia, MD 21045

Telephone

443-324-5289

Facsimile

410-740-8704

Traffic & MVA Hearings

Traffic Citation Evaluation

If you have received a Maryland traffic citation(s), or you were notified by the MVA that they want to suspend or revoke your driver's license, complete this FREE Traffic and MVA Hearing Evaluation Form, or call 443-324-5289 for a initial consultation with Scott Athen.

Please note, if you have been arrested for Driving While Impaired or Driving While Intoxicated, please complete the DWI Arrest Evaluation. If you have been arrested for a non-traffic related incident, please complete the Criminal Arrest Evaluation.

Completion of this survey does not create an Attorney-Client Relationship between the person completing the form and The Law Offices of Scott C. Athen or Scott C. Athen, Esq.  However, the information provided by completing this form is protected under Attorney-Client privilege, and will not be released to anyone other than Scott Athen.  Upon receiving and reading your answers, Scott Athen will contact you (yes, you read that correctly, Mr. Athen will call you himself) by the means chosen at the beginning of the survey to arrange your free initial consultation.

Fields marked '*' are required.

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Full Name*
Street Address*
City*
State*	Alabama Alaska Arizona Arkansas California Colorado Connecticut Deleware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massacheusetts Michigan Minnesota Mississippi Missouri Montana Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip*
E-mail address*
OK to e-mail you at this address?	Yes No
Phone No.*	Home Work Cell Other
OK to call you at this number?	Yes No
Alternate Phone No.	Home Work Cell Other
OK to call at this number?	Yes No
Date of Birth*
Height	Height 4' 0" 4' 1" 4' 2" 4' 3" 4' 5" 4' 6" 4' 7" 4' 8" 4' 9" 4' 10" 4' 11" 5' 0" 5' 1" 5' 2" 5' 3" 5' 4" 5' 5" 5' 6" 5' 7" 5' 8" 5' 9" 5' 10" 5' 11" 6' 0" 6' 1" 6' 2" 6' 3" 6' 4" 6' 5" 6' 6" 6' 7" 6' 8" 6' 9" 6' 10" 6' 11" 7' 0" 7' 1" 7' 2" 7' 3" 7' 4" 7' 5" 7' 6" 7' 7" 7' 8" 7' 9" 7' 10" 7' 11"
Weight	Pounds
Education	Choose One No High School Some High School High School Grad Some College College Degree (2-Year) College Degree (4-Year) Some Graduate Graduate Degree Some Doctorate Doctorate
Marital Status	Chose One Single Engaged Married Separated Divorced Widowed
Number of Children
Employment*	Choose One Accomidation Accounting Agriculture Amusement & Recreation Banks & Financial Institutions Communications Computers Construction Consulting Education Electronics Financial Brokers & Exchanges Fishing Food & Beverage Government - Federal Government - State Governmebt - Local Health & Social Services Homemaker Insurance Legal Manufacturing Mining Oil & Gas Personal/Individual Real Estate Retail Secretarial Security Services Storage & Warehousing Student Telecommunications Utilities Other
Length of employment*	Mo/Yr Months Years
Drivers license No.*
Drivers license State*	Alabama Alaska Arizona Arkansas California Colorado Connecticut Deleware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massacheusetts Michigan Minnesota Mississippi Missouri Montana Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Commercial license?	No Yes
License restrictions
Years driving
Miles driven per year
Date of arrest*
Time of stop
County stopped/arrested in*	Choose One Allegany County Anne Arundel County Baltimore City Baltimore County Calvert County Caroline County Carroll County Cecil County Charles County Dorchester County Frederick County Garrett County Harford County Howard County Kent County Montgomery County Prince George's County Queen Anne's County St. Mary's County Somerset County Talbot County Washington County Wicomico County Worcester County
Street or location of stop*
Name of police department
Officer's name & badge number
Why were you stopped/arrested, according to the Officer?*
Please list all Citation Numbers*
Arrest Code
Please list all charges*	List by Statute Number e.g. 21-801.1
Was there an accident?	Yes No
Was anyone injured?	No one was hurt/Not applicable Myself Passenger(s) in my vehicle Driver/Passenger(s) in another vehicle Pedestrian Not Sure
Were there any witnesses with you who could testify for you?	Yes No
Did you ever ask to speak with a lawyer? If 'yes', when? (please give details)	Yes No
Additional comments

Please click 'Send Traffic Citation Evaluation to Scott Athen' only once.