Request For Court Appointed Attorney And Order {MC 222}

Approved, SCAO Original - Court 1st copy - Defendant 2nd copy - Appointed attorney STATE OF MICHIGAN JUDICIAL DISTRICT JUDICIAL CIRCUIT ORI REQUEST FOR COURT-APPOINTED ATTORNEY AND ORDER CASE NO. Court address Court telephone no. MI- The State of Michigan THE PEOPLE OF v Defendant's name, address, and telephone no. CTN SID DOB REQUEST The defendant requests a court-appointed attorney and submits the following information. 1. CHARGE Next hearing: Date Misdemeanor Felony Paternity Bond posted Bail amount: $ 4. INCOME Employer name and address 2. RESIDENCE Rent Own 3. MARITAL STATUS Single Divorced Married Separated Length of employment Live with parents Room/Board Dependents: Number Average take-home pay $ weekly monthly Other Income State monthly amount and source (DHHS, VA, rent, pensions, spouse, unemployment, etc.). every two weeks 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: *Use other side for additional information/comments. Signature: ORDER 8. Name Bar no. is appointed to represent the defendant. 9. The petition is denied because: American LegalNet, Inc. www.FormsWorkFlow.com Date MC 222 (3/16) Judge Bar no. MCR 6.005(B), MCR 6.610(D),(G) REQUEST FOR COURT-APPOINTED ATTORNEY AND ORDER