Request For Court Appointed Attorney And Order
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Request For Court Appointed Attorney And Order Form. This is a Michigan form and can be use in Appeals Statewide.
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Tags: Request For Court Appointed Attorney And Order, MC 222, Michigan Statewide, Appeals
Original - Court
1st copy - Defendant
2nd copy - Appointed attorney
Approved, SCAO
STATE OF MICHIGAN
JUDICIAL DISTRICT
JUDICIAL CIRCUIT
ORI
CASE NO.
REQUEST FOR
COURT-APPOINTED ATTORNEY
AND ORDER
Court address
Court telephone no.
MIDefendant name, address, and telephone no.
The State of Michigan
THE PEOPLE OF
v
CTN
SID
DOB
REQUEST
The defendant requests a court-appointed attorney and submits the following information.
1. CHARGE
Misdemeanor
Felony
Paternity
Next hearing:
Date
Bail amount: $
4. INCOME Employer name and address
Bond posted
2. RESIDENCE
Rent
Own
3. MARITAL STATUS
Single
Divorced
Married
Separated
Dependents:
Number
Length of employment
Average take-home pay $
weekly
monthly
Other Income
Live with parents
Room/Board
every two weeks
State monthly amount and source (DSS, VA, rent, pensions, spouse, unemployment, etc.).
5. ASSETS*
State value of car, home, bank deposits, inmate accounts, bonds, stocks, etc.
6. OBLIGATIONS*
Itemize monthly rent, installment payments, mortgage payments, child support, etc.
7. CONTRIBUTION TOWARD ATTORNEY COSTS
I understand that I may be required to contribute to the cost of an attorney.
Date:
Signature:
*Use reverse side for additional information/comments.
ORDER
8.
is appointed to represent the defendant.
Name
Bar no.
9. The petition is denied because:
District Court Endorsement
(felony cases only)
Date
Judge
MC 222 (3/09)
Date
Bar no.
Judge
REQUEST FOR COURT-APPOINTED ATTORNEY AND ORDER
Bar no.
MCR 6.005(B), MCR 6.610(D),(G)
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