State of Alabama Unified Judicial System Form C-10B Rev.2/95 ORDER APPOINTING COUNSEL (INDIGENT) Case Number IN THE___________________________________________COURT OF ______________________________________________, ALABAMA (Circuit, District, or Municipal) (Name of County or Municipality). ______________________________________________v. ___________________________________________________ Plaintiff(s) Defendant STATE OF ALABAMA Municipality of _________________________________________________ v. ________________________________________________ Defendant IN THE MATTER OF _____________________________________________________________________________, a child IT IS, THEREFORE, ORDERED AND ADJUDGED BY THIS COURT AS FOLLOWS: Affiant is not indigent and request is DENIED. Affiant is partially indigent and able to contribute monetarily toward his defense; therefore, defendant is ordered to pay $_________________ toward the anticipated cost of appointed counsel. This amount is to be paid to the Clerk of Court or as otherwise ordered and disbursed as follows: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Affiant is indigent and request is GRANTED. The prepayment of docket fees is waived. IT IS FURTHER ORDERED AND ADJUDGED that ____________________________________________________________, is hereby appointed as counsel to represent affiant. (Name of Attorney) IT IS FURTHER ORDERED AND ADJUDGED that the court reserves the right and may order reimbursement of attorney’s fees and expenses, approved by the court and paid to the appointed counsel, and costs of court. Done this________________________ day of ________________________________________, __________ ________________________________________________ Judge American LegalNet, Inc. www.USCourtForms.com