Defense Of Indigents Act Form No 1

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DEFENSE OF INDIGENTS ACT
FORM NO. 1
A STATEMENT OF THE RIGHTS OF AN ACCUSED
You have been arrested and charged with the crime of ____________________________
________________________________________________________________________
You are advised:
(a) You have a right to employ counsel to represent you.
(b) In the even you are financially unable to employ counsel, the State will provide you
with counsel by appointment or with the services of the Public Defender of the County.
If you desire the State to provide you with counsel, you may make application for counsel
on a form which I will give to you.
The form has been read to the accused,_______________________________________,
in my presence, at ______ o’clock p.m. – a.m., this ______ day of _________________,
___________________________________
Clerk of Court
or other Officer
(if the accused cannot employ counsel and does not wish the State to provide him with
counsel at this time, he shall be asked to execute the following statement.)
WAIVER OF RIGHT TO HAVE APPOINTED
COUNSEL OR SERVICES OF PUBLIC DEFENDER
The undersigned certifies that he has been informed of the charges against him and the
nature thereof, and that he is unable to employ counsel. However, the undersigned now
state that he does not at this time desire to apply for the appointment of counsel or for the
services of the Public Defender, and expressly waives his desire to services of counsel
provided by the State at this time, which he understand he has a right to do.
____________________________________
Defendant
Executed before me this __________day of ____________________________, _______.
____________________________________
Signature of Clerk
of Court or Officer

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