Application For Public Defender, Court-Appointed Counsel, Or Guardian Ad Litem
Download a blank fillable Application For Public Defender, Court-Appointed Counsel, Or Guardian Ad Litem in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Application For Public Defender, Court-Appointed Counsel, Or Guardian Ad Litem with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2APPLICATION FOR PUBLIC DEFENDER, COURT-APPOINTED COUNSEL, OR GUARDIAN AD LITEM
Pursuant to §21-1-103, C.R.S, a processing fee of $25.00 may be collected by the court on final disposition of this case.
Court Room:
Case Number:
District:
Most serious charge:
Next hearing date/Type:
All sections must be completed. Print neatly. If an item does not apply, write N/A
Applicant's Employer
Applicant
Company
Name
Mailing Address
Mailing Address
Street Address (if different)
Street Address (if different)
City, State, Zip
City, State, Zip
Phone Number
Phone Number
Length of Employment
Soc. Sec. No.
Birthdate
Hours/Week
Driver's License No.
Pay Dates:
State
Pay Rate
:
Other Household Members (Spouse, Parent, etc.)
Other Household Member's Employer
Name
Company
Relation to Applicant
Mailing Address
Mailing Address
Street Address (if different)
Street Address (if different)
City, State, Zip
City, State, Zip
Phone Number
Phone Number
Length of Employment
Hours/Week
Soc. Sec. No.
Birthdate
Pay Dates:
Pay Rate
State
Driver's License No.
:
Total Number of Dependants (including yourself)
Married
Marital Status
Single
Separated
Divorced
Monthly Expenses (See definitions
Gross Monthly Income (See definitions
Amount
Amount
on reverse for further information.)
on reverse for further information.)
Rent/Mortgage
Self (wages, salary, commission)
Spouse/Other Household Members
Groceries
Parents (if same household)
Utilities
Clothing
Unemployment Benefits
Maintenance/Alimony and/or Child Support
Social Security/Retirement Funds
Maintenance/Alimony
Medical/Dental
Other Income (See Page 2)
Other Expenses (identify source)
Other Income (See Page 2)
Other Expenses (identify source)
Total Household Income
Total Expenses
Assets
Amount
Description
Savings Account Balance
Name of Bank
Checking Account Balance
Name of Bank
Value of Vehicles
Year and Model
Amount Owed:
Value of Recreation Vehicles
Value of House
Type:
Value of Other Property
Type:
Value of Stocks, Bonds, Mutual Funds
Type:
Year and Model
Value of Other Investments
Total Assets
Convertible to Cash =
References:
1. Name/Address/Phone
2. Name/Address/Phone
Guidelines:
At or below or
Above or
Automatically eligible for PD/GAL/RPC (
In custody &/or bond allowed
Out on bond )
Refer to scoring instrument (Criminal, Misdemeanor, Traffic, Juvenile Delinquency cases)
Signature of Investigator/clerk/PD:
Date:
I swear under penalty of perjury that the above-contained information is true and complete. I also understand that if the court grants this request, I
may later be ordered to reimburse the State of Colorado for attorney fees spent on my behalf.
Request:
granted or
denied
ADVERTISEMENT
0 votes
Related Articles
Related forms
Relinquishment Of Minor For Adoption By Parent Or Guardian Or Guardian Ad Litem Of The Mother/father
Legal
Form Laciv 108 - Application For Publication - Superior Court Of California, Coutry Of Los Angeles
Business
Related Categories
Parent category: Legal