Public Defender Application - Pennsylvania Office Of The Public Defender
Download a blank fillable Public Defender Application - Pennsylvania Office Of The Public Defender in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Public Defender Application - Pennsylvania Office Of The Public Defender with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4OFFICIAL USE: PUBLIC DEFENDER SUPERVISOR ONLY: LEAVE BLANK
File # _____________
NCP: ______________
Date: _____________________
ID # ______________
OTHER PRISON: _____________
Approved: ________
OTN # & MDJ _____________________________________
Assignment: _______________
Term # __________________________
Denied: ________
Charges: __________________________________________________________
Reason: ___________________
__________________________________________________________________
Co-Defendants: _____________________________________________________
Interpreter: _________________
PUBLIC DEFENDER APPLICATION
OFFICE OF THE PUBLIC DEFENDER
NORTHAMPTON COUNTY GOVERNMENT CENTER
669 WASHINGTON STREET
EASTON, PA 18042-7464
OFFICE: 610-829-6384
FAX: 610-559-3718
READ AND ANSWER ALL QUESTIONS CAREFULLY AND ACCURATELY
I HEREBY APPLY FOR THE SERVICES OF THE PUBLIC DEFENDER'S OFFICE AND MAKE THE
REPRESENTATIONS WHICH FOLLOW IN ORDER TO QUALIFY FOR SUCH SERVICES. I UNDERSTAND
AND AGREE THAT THESE REPRESENTATIONS ARE NOT OF A CONFIDENTIAL NATURE; MAY BE
REVEALED TO THE COURT OR OTHER INTERESTED PARTY; AND MAY BE USED AGAINST ME IF
PROVED TO BE DELIBERATELY FALSE.
I have read and I understand the above statement: _________________________________________________
SIGNATURE
DATE
1.
Full Name:
All Nicknames/Aliases:
2.
Date of Birth:
3.
Social Security No.:
4.
Address:
City/State/Zip:
Length of Time at this Address:
Do you own or rent the premises at which you reside: Own:
Rent:
If neither, who owns this property:
5.
Home Phone Number:
Cell Phone Number:
6.
Citizenship Status (Check One and Provide the Required Information):
Born in the United States: Where:
Naturalized Citizen: Date you became citizen:
Legal alien
Not a citizen:
Country of citizenship:
7.
Marital Status (Check One)
Single
Divorced
Separated *
Married
Widow/Widower
8.
Spousal Information (If Applicable):
Spouse’s Name:
Spouse’s Address (If different from above):
Spouse’s Date of Birth:
ADVERTISEMENT
0 votes
Related Articles
Related forms
Hazardous Materials Technician Skill Sheets - Pennsylvania Office Of The State Fire Commissioner
Legal
Application For Registration Foreign Statutory Trust - 2009 - Office Of The Secretary Of The State Of Connecticut
Legal
Application For Registration Foreign Limited Liability Company - Office Of The Secretary Of The State O Connecticut
Legal
Application Form For Payroll Deduction - Office Of The Secretary Of State - State Of South Carolina
Legal
Related Categories
Parent category: Business