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Request for Court-Appointed Attorney and Order (MC 222)

  1. REQUEST: The defendant requests a court-appointed attorney and submits the following information:
  2. Residence*
  3. Marital Status*
  4. Amount Per:*
    I understand that I may be required to contribute to the cost of an attorney.
  6. Electronic Signature Agreement*
    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. I have reviewed this document and the statements it contains are true to the best of my knowledge, information, and belief.
  7. ORDER
    __________________________________________ is appointed to represent the defendant. (include Name and Bar number)
  8. The petition is denied because: Applicant deemed not indigent ______ Convictions will not result in mandatory jail time ______
  9. Date
  10. Judge / Bar no.
  11. Mailed ______ Handed to Defendant ______ Date ______________________ Initials ______
  12. MCR 6.005(B), MCR 6.610(D),(G)
  13. Leave This Blank:

  14. This field is not part of the form submission.