City of Wyoming, MI

REQUEST FOR APPOINTMENT OF ATTORNEY

Defendant's Name*

THE PEOPLE OF*

The State of Michigan

CITY OF WYOMING

Defendant's FULL Address*

v

Defendant's Phone #*

Defendant's Email*

REQUEST

The defendant requests the appointment of an attorney and submits the following information:

1. CHECK ALL THAT APPLY

I am under the age of 18

I am currently serving a sentence in
jail or prison

I receive public assistance

I am receiving residential treatment in a
mental health or substance abuse facility

2. CHARGE*

Next Hearing Date

Misdemeanor

Felony

Paternity

Bail Amount

Bond Posted

3. RESIDENCE*

Rent

Own

Live with relative(s)

Room/Board

4. MARITAL STATUS*

Single

Married

Divorced

Separated

Dependents?

Number of Dependents:

5. INCOME

Employer name and address*

Length of
employment*

Average take
home pay*

Frequency*

weekly

bi-weekly

monthly

Other Income - State monthly amount and source (MDHHS, VA, rent, pensions, spouse, unemployment, etc.)*

6. ASSETS - State value of car, home, bank deposits, inmate accounts, bonds, stocks, etc.*

7. OBLIGATIONS - Itemize monthly rent, installment payments, mortgage payments, child support, etc.*

8. ATTORNEY COSTS

I understand that a decision will be made on whether I can afford an attorney. I understand that I may be required to contribute to the cost of an attorney. I understand that I may contest my ability to pay any ordered costs if the court attempts to collect any costs for an attorney, and the court must determine whether and how much, if any amount, I would be required to pay based on my ability to pay at that time.

I attest that I have read and agree with the above statement.

RESRent

RESOwn

RESFam

RESRoom

weekly

biweekly

monthly

MaritalSin

MaritalMar

MaritalDiv

MaritalSep

SOM

COW

Defendant_NAT

EmailSubject

Under18

Incarcerated

PublicAssist

Hospitalized

Submit

* Required

Application for Attorney

REQUEST FOR APPOINTMENT OF ATTORNEY

REQUEST

City of Wyoming, Michigan | 1155 28th St SW, Wyoming, MI 49509 | 616-530-7226 | Fax 616-530-7200
Hours of Operation: Monday - Thursday, 7:00 A.M. to 5:00 P.M. | Closed Friday - Sunday

Application for Attorney

REQUEST FOR APPOINTMENT OF ATTORNEY

REQUEST

City of Wyoming, Michigan | 1155 28th St SW, Wyoming, MI 49509 | 616-530-7226 | Fax 616-530-7200Hours of Operation: Monday - Thursday, 7:00 A.M. to 5:00 P.M. | Closed Friday - Sunday

City of Wyoming, Michigan | 1155 28th St SW, Wyoming, MI 49509 | 616-530-7226 | Fax 616-530-7200
Hours of Operation: Monday - Thursday, 7:00 A.M. to 5:00 P.M. | Closed Friday - Sunday