APPLICTION FOR PUBLIC DEFENDER, COURT-APPOINTED COUNSEL, OR
GUARDIAN AD LITEM
General Information
It is important that you accurately complete all sections of this form as appropriate based on your
personal circumstances. If a section does not apply, please write N/A .
A.
Gross Monthly Income. Includes income from all members of the household who contribute monetarily to
the common support of the household.
Income categories to include:
Wages, including tips, salaries, commissions, payments received as an independent contractor for
labor or services, bonuses, dividends, severance pay, pensions, retirement benefits, royalties,
interest/investment earnings, trust income, annuities, capital gains, unemployment benefits, Social
Security Disability (SSD), Social Security Supplemental Income (SSI), Workman’s Compensation
Benefits, and alimony.
Note: Income from roommates should not be considered if such income is not commingled in accounts or
otherwise combined with the applicant’s income in a fashion which would allow the applicant proprietary rights
to the roommate’s income.
Income categories do not include:
TANF payments, food stamps, subsidized housing assistance, veteran’s benefits earned from a
disability, child support payments, or other public assistance programs.
B.
Liquid Assets. Includes cash on hand or in accounts, stocks bonds, certificates of deposit, equity, and
personal property or investments which could readily be converted into cash without jeopardizing the
applicant’s ability to maintain home and employment.
C.
Expenses. Nonessential items such as cable television, club memberships, entertainment, dining out,
alcohol, cigarettes, etc., shall not be included. Allowable expense categories are listed on JDF 208.
JDF 208
R7/06 APPLICATION FOR PUBLIC DEFENDER, COURT-APPOINTED COUNSEL, OR GUARDIAN AD LITEM
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