Application For Appointment Of Counsel (Third District)
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Application For Appointment Of Counsel (Third District) Form. This is a California form and can be use in Third Appellate District Court Of Appeals.
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Tags: Application For Appointment Of Counsel (Third District), California Court Of Appeals, Third Appellate District
IN THE
COURT OF APPEAL OF THE STATE OF CALIFORNIA
IN AND FOR THE
THIRD APPELLATE DISTRICT
APPLICATION FOR APPOINTMENT OF COUNSEL
I hereby request the court to appoint an attorney to represent me at public expense. In support of
such request, I am submitting the following information under penalty of perjury.
FAMILY INCOME:
1.
Gross Monthly Income: Husband: $ ________________; Wife: $ ________________
2.
Source of Income:
________________________________________________________________________
________________________________________________________________________
MONTHLY EXPENSES:
3.
Rent or Mortgage Payments:
4.
Food and Clothing:
5.
Transportation and Utilities:
6.
Medical, Dental & Child Care:
7.
Other Debts (Explain in Item 17):
Total Monthly Expenses:
$
$
$
$
$
$ ____________________
FAMILY ASSETS:
Value
$
$
$
$
$
$
$
Owing
8.
9.
10.
11.
12.
13.
Cash or savings:
Residence:
Furniture:
Cars, trucks or other vehicles:
Real Estate or other Investments:
Other Assets:
TOTAL:
$
$
$
$
$
$
$
14.
15.
16.
Are you presently confined in jail or prison: _____ Yes _____ No
Number of dependents: _____
Number and ages of children dependent on you for support: _______________________
17.
Please write additional comments on reverse side.
I declare under penalty of perjury under the laws of the State of California that the
foregoing is true and correct.
Dated: _________________ Signed: __________________________________________
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