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Steps
1.
Step One
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This section is incomplete
2.
Application for Appointment of Counsel and Certificate of Financial Resources
This section is complete
This section is incomplete
3.
Order
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This section is incomplete
Step One
In the Municipal Court of the City of South Fulton State of Georgia
City of South Fulton V.
Defendant
Citation Number(s)
Charge(s)
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Application for Appointment of Counsel and Certificate of Financial Resources
In Jail
Out on Bond
Arrest Date
Arrest Date
I am the defendant in the above-styled action. I am charged with the offense(s) of:
which is / are a misdemeanor. I cannot afford to hire an attorney to assist me. I would like for the court to determine my eligibility for a Court-Appointed attorney to defend me on the above charge(s).
Name
Address
City
State
Zip Code
Home Phone Number
Work Phone Number
Birth Date
Birth Date
Age
Highest Grade Completed in School
Sex
Race
If employed, employer is:
City and state of employer:
Net take home pay is (gross pay minus state, federal, and social security taxes):
Weekly
Monthly
If unemployed, how long?
List other sources of income such as unemployment compensations, welfare or disability income and the amounts received per week or month:
Are you:
Married
Single
Divorced
Widowed
Is spouse employed?
Yes
No
If yes, by whom?
Spouses net income (week):
Number of children living in the home:
Ages
Dependants other than spouse or children in home (names, relationship, amount contributed to support):
Do you own or are you purchasing a motor vehicle?
Yes
No
Year and Model
Amount owed on it?
Do you own a home?
Yes
No
Value
Amount owed on it?
Amount of house payment or rent payment per month:
List checking or savings or other deposit accounts with any bank or financial institution and the amount in each account:
List any other assets or property, including real estate, jewelry, notes, bonds or stocks:
List indebtedness and amount of payments (include utilities, groceries, credit cards, loans other than car and house):
List any extraordinary living expenses and monthly (such as regularly occurring medical bills):
Child support payable under any court order?
Do you understand that whether you are convicted, acquitted, have your case bound over to State Court or otherwise dispose of your charge(s), City of South Fulton may seek reimbursement of attorney’s fees pad for you, if you become financially able to pay?
Defendant's initials
I have read (had read to me) the above questions and answers, and they are correct and true. I agree to reimburse the City of South Fulton for attorney’s fees paid on my behalf if ordered to do so.
The undersigned swears that the information gin herein is true and correct and understands that a false answer to any item may result in a charge of perjury.
Date
Date
Defendant
Sworn to and subscribed before me this:
Sworn to and subscribed before me this:
Notary Public
Commission Expires:
Seal
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Order
Having considered the above matter, it is the finding of this court that the above-named defendant is / is not indigent and is / is not entitled to have an appointed counsel.
It is ordered that the clerk assign an attorney to represent the defendant in the above case.
Let the defendant and the assigned attorney be notified hereof and furnished a copy of this application.
Judge
Municipal Court of the City of South Fulton
Case assigned to:
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