RIGHTS TO COUNSEL

1

Name:* This field is required.

First Name

Last Name

2

Case#:* This field is required.

If you do not have your case number, you can enter your Citation number or zero's.

3

Right to Counsel Form:* This field is required.If you do not understand this document you should appear before the judge in open court before signing it.

4

At this time, I (choose one):* This field is required.

I wish to be screened for a court-appointed attorney.

I want additional time to retain my own attorney

I am represented by an attorney. My attoenye's name is:

I waive my right to be represented by an attorney, understanding, however, that I have a right to request to be represented by an attorney at any time before a final resolution of my case(s).

5

You have chosen to be screened for a court-appointed attorney:* This field is required.

6

My attorney's name is: Attorney Name * .

7

Date* This field is required.READ ONLY- This field is pre-filled for you. Please click next.

Date

8

Signature* This field is required.

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