Opd Withdrawal Form printable pdf download

Opd Withdrawal Form

OPD WITHDRAWAL FORM

Date:

Client Name:

AKA:

Address:

Phone:

DOB:

JCN:

CCN:

Cause Number:

Charge:

 Felony

 Juvenile

 Dependency

 Civil Contempt

Case Type:

 KC Misdemeanor  ITA

 Other

Date Discovery Received:

Date Conflict Identified:

REASON FOR WITHDRAWAL:

 Conflict of Interest  Other

 Defendant Retained Private Counsel: (Name of Attorney)

CONFLICT INFORMATION:

This Agency’s conflict is with: Name

DOB:

Co-Defendant in Current Case?  Yes

 No

Cause Number:

 Victim/Client

 Suspect/Client

 Witness/Client

 Other



Irreconcilable breakdown in client communication

OTHER NAMES IN DISCOVERY:

STATUS

REPRESENTATION

DOB

IN CASE

HISTORY

NAMES

 SEE ATTACHED SHEET FOR ADDITIONAL LISTINGS

Client is  In-Custody  Out-of-Custody

Received Conflict From:

HEARING SCHEDULE:

Trial Date:

Next Hearing:

Type of Hearing:

Withdrawal Hearing Date:

(Must be at least two full working days from this Notification of

Withdrawal if trial date has been set. Agency must notify PA and co-defendant counsel, if any.)

LOCATION OF DISCOVERY:

 PA’s Office

 Agency will forward to new counsel

 Other

REQUEST FOR CREDIT/DEBIT:

 Withdrawal within 14 days of assignment

 Substantial advice

 One credit (explanation must be attached)

 Other

(explanation must be attached)

This form filled out by:

Date:

APPROVED BY:

Date:

OPD USE ONLY

OPD REASSIGNED TO:

INITIALS:

DATE:

 FAX

 Interoffice Mail

Opd Withdrawal Form

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