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Application for Assignment of Public Defender

  1. Lake Forest Park Municipal Court - Application for Assignment of Public Defender
    CONFIDENTIAL PER RCW 10.101.020(3)
  2. Select the types of assistance you receive:*
  3. Do you work or have a job?*
  4. Do you have a spouse that lives with you?*
  5. Does he/she work?
  6. Do you and/or your spouse receive unemployment, Social Security, a pension, or workers' compensation?*
  7. Do you receive money from any other source?
  8. Do you have children living with you?*
  9. Do you own a home?*
  10. Do you own a vehicle or vehicles?*
  11. Other than routine monthly living expenses such as rent, utilities, food, etc., do you have other expenses such as child support payments, court-ordered fines, medical bills, etc.?*
  12. Do you have money available to hire a private attorney?*
  13. After completing the above, please READ and ELECTRONICALLY SIGN, below.
  14. 1) I understand the court may require verification of the information provided above.
  15. 2) I agree to immediately report any change in my financial status to the court.
  16. 3) I certify under penalty of perjury under the laws of Washington State that I have read the foregoing statements in the application, know the contents thereof, and believe them to be true and correct. (Perjury is a criminal offense-see Chapter 9A.72 RCW).
  17. Electronic Signature Agreement:*
    By checking the "I agree" box above, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  18. Last name, first name, middle initial
  19. OPT-IN for Court Date Reminder Text Message Reminders
    Please provide your cell phone number below to opt-in for text message reminders of future court hearings. Non-delivery or non-receipt of a text message does not release you of your obligation to appear if you have been previously noticed. Standard text messaging rates may apply.
  21. Leave This Blank:

  22. This field is not part of the form submission.