United States District Court CENTRAL DISTRICT OF ILLINOIS PEORIA DIVISION _______________________________ Plaintiff(s) vs. _______________________________ Defendant(s) ) ) ) ) ) ) ) ) Case Number:_______________________ MOTION FOR APPOINTMENT OF COUNSEL I,____________________________________________________, declare that I am the (circle one) Plaintiff Defendant In the above-entitled proceeding and state that I am unable to afford the services of an attorney, and hereby request the Court to appoint counsel to represent me in this proceeding. In support of my motion, I declare that I have made the following attempts to retain counsel to represent me in this proceeding: In further support of my motion, I declare that (check appropriate box): I am not currently, nor previously have been represented by an attorney appointed by the Court in this or any other civil or criminal proceeding before this Court. I am currently, or previously have been, represented by an attorney appointed by this Court in the proceeding(s) described on the back of this page. In further support of my motion, I declare that (Check appropriate box) I have attached an original Application to Proceed In Forma Pauperis detailing my financial status. I have previously filed an Application to Proceed In Forma Pauperis in this proceeding and it is true and correct representation of my financial status. I have previously filed an Application to Proceed In Forma Pauperis in this proceeding; however, my financial status has changed and I have attached an amended Application to Proceed In Forma Pauperis to reflect my current financial status. I declare under penalty of perjury that the foregoing is true and correct. Date:________________ ___________________________________ Movant’s Signature ___________________________________ Street Address ___________________________________ City/State/Zip 2000 (C) American LegalNet, Inc.