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 Clear My Record Prop 47 Prop 64 Name First Last Email PhoneAddress 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 NumberPlease type your driver's license and the issuing State.Date of Birth Date Format: 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 ownHouseVehicle #1Vehicle #2Checking AccountSavings AccountOtherYour ExpensesRent or MortgageCar Payment(s)Medical Payment(s)Loan Payment(s)ClothingLaundryFoodWAIVER OF HEARING REGARDING PUBLIC DEFENDER FEES AND CONSENT TO COURT ORDER WAIVER OF HEARING REGARDING PUBLIC DEFENDER FEES AND CONSENT TO COURT ORDER Penal Code Section 987.8: In any case in which a defendant is provided an attorney, either a Public Defender or Court-appointed counsel, upon conclusion of the criminal proceedings, or withdrawal of the Public Defender, the Court may, after notice and a hearing, make a determination of the present ability of the defendant to pay all or a portion of the cost of that legal representation. The Court may hold an additional hearing within six (6) months of the conclusion of the criminal proceedings. The Court may order a defendant to appear before a county officer to inquire into the defendant’s ability to reimburse the county for legal assistance. Choose One OPTION 1: I AGREE TO WAIVE, my right, pursuant to Penal Code Section 987.8, to a Court hearing on the issue of attorney fees. I further understand and agree that, although the Court does not have to accept this waiver, the Court MAY enter a judgment against me for a flat fee of $150 ( for a misdemeanor)/$300 (for a felony), as my contribution toward my legal representation by the Public Defender. Initial Initial Here OPTION 2: I DO NOT AGREE TO WAIVE the right to have a Court hearing on the issue of attorney fees AND I understand that the Court will assess attorney fees at $192.00 for each hour the Public Defender worked on my case, subject to my ability to pay AND this amount may likely be inexcess of the flat fee of $150 (misdemeanor) or $300 (felony). Initial Initial Here 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 Date Format: MM slash DD slash YYYY Date
