Apply for a Public Defender APPLICATION TO ENLIST THE SERVICES OF A PUBLIC DEFENDER Application to enlist the services of the public defender I am requesting to be represented by the Public Defender because I am not financially able to hire private counsel. How can we help you?* First Court Date For assistance with: Clear My Record, Prop 47, Prop 64, and 290 Relief click here: Fresh StartName First Last PhoneDate of Birth MM slash DD slash YYYY Email 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 Occupation Please state your occupation and your employer's address and phone number.Annual Income Please state how much money you earn annually.Your ExpensesRent 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. Signature* Date* MM slash DD slash YYYY DateCAPTCHA
