Apply for a Public Defender

The Public Defender’s office provides representation in criminal, juvenile, mental health, and probate for those unable to afford a private lawyer. If you qualify for our services, you will meet with a Public Defender Attorney at your first Court date. Attorneys are assigned after the Court has appointed the Public Defender as your legal counsel. You do not need to apply for a public defender in advance of your first court date.

I am requesting to be represented by the Public Defender because I am not financially able to hire private counsel.

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First Court Date

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Name

First Last

Date of Birth

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Citizenship Status

U.S Citizen

Non-U.S. Citizen

Military

I am unable to hire a private attorney based upon the following facts and circumstances:

Employed?

Employed

Unemployed

Employer Name

Employer Phone

Employer Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your Occupation:

Annual Income

Please state how much money you earn annually.

Your Expenses

Rent or Mortgage

Car Payment(s)

Medical Payment(s)

Other Loans

Insurance

Other

I declare under penalty of perjury that the foregoing is true and correct. I hereby authorize the County of Ventura and its duly authorized representatives to contact any employer, bank, savings and loan, credit union, creditor, insurance company, attorney at law, or government agency regarding my financial condition, and I further authorize such institution, individual, partnership, corporation or agency so contacted to release any and all information requested regarding my assets, liabilities, policies, litigations, financial transactions and accounts.

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Date*

Date

Name

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