IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT ) ) ) ) ) ) ) ) ) ) ) CASE NO. REQUEST FOR APPOINTED ATTORNEY ) I request that the court appoint an attorney to represent me (or my child because I cannot afford to pay for one. I understand that: 1. 2. I must provide all financial information requested by the court so the court can decide if an attorney should be appointed. Any financial information provided by me may be made available to the Attorney General after the conclusion of this case. If I give false information, the false information may be used to prosecute me for perjury under Alaska Statute 11.56.200. If my financial situation changes and I do not report this to the court, the law requires my appointed attorney to do so. At the conclusion of this case, the court will enter a judgment against me which will require me to pay $500 or the actual cost of my appointed attorney, whichever is less. After the judgment is entered, I may request the court to reduce the amount of the judgment if payment would cause manifest hardship to me or my family. GENERAL WAIVER I authorize anyone to release to the Alaska Court System all information concerning my assets, liabilities, account balances and any income source I have had for the past three years. This includes but is not limited to all current and past employers, banks, credit and depository institutions, accountants, brokers and credit bureaus. 3. 4. Date Signature Type or Print Name Date of Birth TF-929 (3/16)(cs) REQUEST FOR APPOINTED ATTORNEY American LegalNet, Inc. www.FormsWorkFlow.com Admin. R. 12(e)&(f)