- Caddo Parish Public Defender's Office

APPLICATION FOR COURT APPOINTED LAWYER

In accordance with La. R.S. 15:175, before any person asserting indigency and requesting representation by a court appointed lawyer may be considered for those services he or she must do the following:

1. Complete an application for those services.
2. Provide complete and accurate information about his or her financial status.
3. Pay a Non-Refundable Application Fee of $40.00, unless waived for good cause.

APPLICANT HEREBY AFFIRMS UNDER PENALTY OF PERJURY that he or she desires counsel but is financially unable to procure those services and the following information concerning his or her financial means and obligations is true and correct to the best of his or her knowledge. Applicant also agrees to report in writing any change in his or her address or financial status to Public Defender’s Office. Failure to remit payment will result in your Tax refund being deducted by the amount in which you owe this office plus any required processing fees.

Select Court:

District Juvenile City

District Court Application

(* denotes a required information)

First Name *

Last Name *

DOB *

SSN

Address *

Apt #

City *

State *

Zip *

Total Number of People Living in Household *

Residential Status

Own Rent Other

Home Phone # *

TOTAL HOUSEHOLD INCOME (Employer/Source)

Applicant

Income ($)

Spouse

Income ($)

Other Members

Income ($)

ASSETS / SOURCES OF INCOME
NOTE: Other Sourses of Income include the following:
(Alimony, Child Support, SSI, Worker’s or Unemployment Compensation and Food Stamps):

Checking ($)

Savings ($)

Other ($)

Auto ($)

Boat ($)

MONTHLY EXPENSES

Note/Rent ($)

Utilities/Phone ($)

Misc Expenses ($)

Car Note ($)

Child Support ($)

BAIL BONDS

Bond Amount ($)

Bondsman

NOTICE: If you are requesting a court appointed attorney, you must complete this application and pay a $40 application fee. If you cannot afford to pay this, all or part of it may be waived upon the showing of good cause. Submit application for payment options!