CR-191 SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: FOR COURT USE ONLY PEOPLE OF THE STATE OF CALIFORNIA VS. DEFENDANT: DECLARATION OF COUNSEL FOR APPOINTMENT IN CAPITAL CASE CASE NUMBER: I request appointment under rule 4.117 of the California Rules of Court (please check 1 or 2): 1. 2. a. b. c. My qualifications are set forth in the declaration on file with this court. My qualifications are (attach additional sheets if necessary): I am an active member of the State Bar of California. My State Bar number is: I am admitted to practice pro hac vice pursuant to rule 9.40. I have the following criminal or civil trial experience (specify case name, number, county, judge, and your role, including whether you were lead or associate counsel): d. I have the following experience in death penalty trials (specify case name, number, county, judge, and your role, including whether you were lead or associate counsel): e. I have the following experience with expert witnesses and psychiatric and forensic evidence (specify): f. In the past (specify): years, I have completed (specify): hours of specialized training in the defense of persons accused of capital crimes (specify nature of training): g. I have ongoing consultation support from the following experienced death penalty counsel (name and address): h. I am certified by the State Bar of California's Board of Legal Specialization as a criminal law specialist. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: (TYPE OR PRINT NAME) (SIGNATURE) Page 1 of 1 Form Adopted for Mandatory Use Judicial Council of California CR-191 [Rev. January 1, 2007] DECLARATION OF COUNSEL FOR APPOINTMENT IN CAPITAL CASE Penal Code, § 992 www.courtinfo.ca.gov American LegalNet, Inc. www.FormsWorkflow.com