IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA IN AND FOR THE FIFTH APPELLATE DISTRICT People of the State of California, Case No. vs. County: County Case No. . Defendant / Appellant. APPLICATION FOR APPOINTMENT OF COUNSEL I, , appellant in the above-entitled cause, now pending in the Court of Appeal, Fifth Appellate District, do hereby request the court to appoint an attorney to represent me in this matter. In support of this request, I do hereby certify (or declare) under penalty of perjury that I have no income or assets except as follows: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Dated: ________________ ____________________________________ Signature of Appellant CERTIFICATE OF PRISON OFFICIAL I, the warden or other duly constituted authority, certify that the above-named appellant does not have money or other property on deposit in the prison, except for $_________________. ___________________________________________ (Signature) _____________________________ (Title) American LegalNet, Inc. www.USCourtForms.com