SUPERIOR COURT OF CALIFORNIA COUNTY OF YUBA 215 Fifth Street, Suite 200 Marysville, CA 95901 (530) 749-7600 REQUEST FOR APPOINTMENT TO COURT APPOINTED COUNSEL LIST The undersigned request appointment: (check appropriate box) CRIMINAL Misdemeanor General Felony Sexually Violent Predator Three-Strike Cases Homicide ARBITRATION Personal Injury Property Damage Business Law General Civil Wrongful Death JUVENILE FAMILY LAW Counsel for Minor Contempt CIVIL MEDIATION PROBATE Guardianships Conservatorships DISCOVERY REFEREE Please provide a brief summary of experience in the area(s) checked. (Unless the Presiding Judge is sufficiently familiar with your experience.) The undersigned declares under penalty of perjury that the foregoing is true and correct. Executed on _____, at ______ , California. __________________________ Signature __________________________ Type or Print Name The above-named attorney is qualified and placed on the Court Appointed Counsel list. DATED: ______________________________ DEBRA L. GIVENS JUDGE OF THE SUPERIOR COURT REQUEST FOR APPOINTMENT TO COURT APPOINTED COUNSEL LIST G09063 ___________________________________________________________________________ Yuba County Superior Court Effective 1/12/10 American LegalNet, Inc. www.FormsWorkFlow.com