Application For Court Appointment Certification Page 2
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10FIRST JUDICIAL DISTRICT OF PENNSYLVANIA
APPLICATION FOR COURT APPOINTMENT CERTIFICATION
(NON-HOMICIDE)
PLEASE TYPE OR WRITE LEGIBLY
NAME ___________________________
PA ATTORNEY ID _________________
PRINCIPAL PHILADELPHIA OFFICE
HOME ADDRESS
__________________________________
(optional) _________________________
__________________________________
__________________________________
__________________________________
__________________________________
OFFICE PHONE____________________
HOME PHONE_____________________
SOCIAL SECURITY NO._____________
Date of Admission to:
PA Bar ____________________________
Other Courts ________________________
________________________
Please list foreign languages in which you are fluent (if any).
In which category(ies) of cases do you wish to accept appointment?
1.
Felony
______
2.
Misdemeanor
______
3.
Non-homicide appellate
______
4.
Non-homicide PCRA
______
5.
Major felony juvenile
______
6.
Non-major felony juvenile
______
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