Public Defender Application - Pennsylvania Office Of The Public Defender Page 3
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413. Case Information (Criminal Complaint Paper Required)
I am named as Defendant in a criminal action in which it is alleged that I committed the crime(s) of:
Said alleged crime(s) occurred at:
Said alleged crime(s) occurred on (date & time):
I
have
have not had a preliminary hearing in this matter before a District Judge.
Name of the District Judge who heard/will hear my case:
Date of Preliminary Hearing:
Name of Co-Defendant(s) in this criminal action:
*If this application is for a State P.V., please indicate here:
14. My Present Status (Check One)
I am on my own recognizance
I am in jail at
and am unable to post bail in the amount of $
I am in jail at
and bail has been denied.
I am out on bail in the amount of $
and said bail was posted by:
Relationship to you:
I am out on unsecured bail in the amount of $
15. Attorney Information
I am financially unable to procure the services of an attorney
Yes
No
I am unable to obtain funds from anyone to help procure the services of an attorney
Yes
No
I have consulted the following attorney(s) about my case:
I have previously been represented by the following attorney(s):
Name of any Public Defender that represented you in Northampton County:
**Continue to next page
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