UNITED STATES DISTRICT COURT
DISTRICT OF NEW HAMPSHIRE
IN RE THE MATTER OF:
Case No. _________________________
REQUEST FOR APPOINTMENT OF COUNSEL
respectfully request appointment of counsel to represent me as a
G grand jury target
G criminal defendant
G grand jury witness
G trial witness
G other: ______________________________________________________________________
I am financially unable to hire counsel. A completed Financial Affidavit is
I declare under penalty of perjury that the foregoing is true and correct.
Signature of Petitioner
NOTE FOR GRAND JURY OR WITNESS REPRESENTATION REQUESTS: In order for
a request for counsel to be considered by the court, the petitioner must attach either
a 1) grand jury target letter, or 2) witness subpoena.
RULING BY JUDICIAL OFFICER
Request Approved. Appoint counsel.
U.S. Magistrate Judge
USDCNH-17 (Rev. 5-07) (Previous Editions Obsolete)