Apply for a Public Defender

APPLICATION TO ENLIST THE SERVICES OF A PUBLIC DEFENDER

Application to enlist the services of the public defender

We cannot discuss your case with you until we are appointed by the judge. Appointment takes place at the first hearing. After we are appointed by the Judge, we will schedule an appointment with you to talk about the details of your case.

How can we help you?*
- First Court Date
For assistance with: Clear My Record, Prop 47, Prop 64, and 290 Relief click here: Fresh Start
Name
First Last
Email
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Social Security Number (only the last four numbers)

Please type only the last four numbers of your social security number.
Driver's License Number

Please type your driver's license and the issuing State.
Date of Birth
MM slash DD slash YYYY
Marital Status
- Single
- Married
- Divorced
- Separated
- Widowed
Do you have children? What are their ages?

Type how many children you have and their age.
Occupation Please state your occupation and your employer's address and phone number.
How much money do you earn?

Please state how much money you earn and how often (weekly, biweekly, monthly)
What you own
House*
Vehicle #1*
Vehicle #2*
Checking Account*
Savings Account*
Other*
Your Expenses
Rent or Mortgage*
Car Payment(s)*
Medical Payment(s)*
Loan Payment(s)*
Clothing*
Laundry*
Food*
I have read the information contained in the Financial Statement and 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.
Signature*
Date
MM slash DD slash YYYY

Date
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Application to enlist the services of the public defender

What you own

Your Expenses

Contact Information

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