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The defendant requests a court-appointed attorney and submits the following information.
Employer name and address
State value of car, home, bank deposits, inmate accounts, bonds, stocks, etc.
Itemize monthly rent, installment payments, mortgage payments, child support, etc.
I understand that I may be required to contribute to the cost of an attorney.
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
Name and Bar no.
MCR 6.005(B), MCR 6.610(D),(G)
This field is not part of the form submission.
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