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Notice Of Right To Timely Appeal Following Trial Or Contested Probation Revocation Hearing Or Conditional Plea CC 265a - Michigan
| Notice Of Right To Timely Appeal Following Trial Or Contested Probation Revocation Hearing Or Conditional Plea Form. This is a Michigan form and can be used in Appeals Statewide . |
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Original - Trial court 1st copy - Prosecutor Approved, SCAO 2nd copy - Defendant/Juvenile for return 3rd copy - Defendant/Juvenile STATE OF MICHIGAN NOTICE OF RIGHT TO TIMELY APPEAL CASE NO. JUDICIAL CIRCUIT FOLLOWING TRIAL / CONTESTED COUNTY PROBATION REVOCATION HEARING / CONDITIONAL PLEA Judge: Court address Court telephone no. Defendant/Juvenile name, address, telephone no., and date of birth THE PEOPLE OF THE STATE OF MICHIGAN v The following notice is given to you to comply with the Michigan Court Rules [either MCR 6.425(E), 6.301, or 6.445(H)]. 1. You are entitled to appellate review of your conviction and sentence. 2. If you are financially unable to retain a lawyer, the court will appoint a lawyer to represent you on appeal. 3. The request for a lawyer must be completed and sent directly to the court at the address noted above within 42 days after sentencing. The financial schedule on the back of this form must be completed. RECEIPT OF NOTICE OF APPEAL RIGHTS On this day I received this form and financial schedule. I understand that I must return the completed Request for Appointment of Lawyer to the court within 42 days if I want an attorney appointed for my appeal. Date Signature of defendant/juvenile REQUEST FOR APPOINTMENT OF LAWYER AND AFFIDAVIT OF INDIGENCY I request appointment of a lawyer to appeal my conviction and sentence. The affidavit of indigency and financial schedule on the back of this form is submitted to show my financial condition. Date Signature of defendant/juvenile NOTE TO DEFENDANT/JUVENILE: After completing the request for appointment of lawyer and the affidavit of indigency and financial schedule, keep one copy for yourself and return the other copy to the court. CC 265a (3/01) NOTICE OF RIGHT TO TIMELY APPEAL FOLLOWING TRIAL / CONTESTED PROBATION REVOCATION HEARING / CONDITIONAL PLEA MCR 6.425(E)<<<<<<<<<********>>>>>>>>>>>>> 2 AFFIDAVIT OF INDIGENCY AND FINANCIAL SCHEDULE I request a court appointed attorney and submit the following information: 1. RESIDENCE Rent Own Live with parents Room/Board Prison Number 2. MARITAL STATUS Single Married Divorced Separated Dependents: Number3. INCOME a. Employer name and address b. Length of employment c. Average of pay weekly monthly every two weeks Gross: $ Net: $ d. Other income (state monthly amount and source [DSS, VA, rent, pensions, spouse, unemployment, etc.]) If no income, state NONE.4. ASSETS State value of car, home, bank deposits, inmate accounts, bonds, stocks, etc. If no assets, state NONE. Attach an account statement and certification for assets in prison accounts. 5. OBLIGATIONS Itemize monthly rent, installment payments, mortgage payments, child support, etc. 6. REIMBURSEMENT I understand that I may be ordered to reimburse the court for all or part of my attorney and defense costs. Signature Name (type or print) Address City, state, zip Subscribed and sworn to before me on , County, Michigan Date My commission expires: Signature: Date Notary public
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