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Marion County Drug Treatment Diversion Program
Participant Referral Form
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Defendant Name: |
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Address: |
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Home Phone Number |
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Cell Number |
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Gallery Number |
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Current Charge |
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Cause Number/ Agency Case Number |
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Person Making Referral |
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Agency |
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Address |
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Phone Number |
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E-mail |
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Comments |
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Please attach the probable cause affidavit, charging information and criminal history and or agency report and submit to:
Jennifer Fillmore Program Coordinator via e-mail jfillmor@indygov.org, fax 317-327-4920 or mail to 251 East Ohio St. Suite 850, Indianapolis, IN 46204.
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