Application For Appointed Defense Services printable pdf download

APPLICATION FOR APPOINTED DEFENSE SERVICES

(To acc omp any Financial Affidavit)

STATE VS. _______________________________ DISTRICT COURT CASE NO. _____________

IN RE:____________________________________ COUNT Y _____________________________

NOTICE TO APPLICANT:

ANY DEFEND ANT CHA RGED W ITH A FELONY VIOLA TION, ENTITLED TO AN A TTORNEY PU RSUANT TO

K.S.A. 22-4503, IS REQUIRED BY LAW TO PAY A $100 BOARD OF INDIGENTS DEFENSE SERVICES APPLICATION

FEE, UNLESS THE FEE IS WAIVED BY THE COURT. THE FEE IS TO BE PAID TO THE CLERK OF THE DISTRICT

COURT. FAILURE TO PAY THIS FEE MAY BE CONSIDERED A VIOLATION OF THE CONDITIONS OF YOUR

RELEASE AND YO UR BON D M AY BE REVO KED FOR FAILURE TO PAY SAID APPLICATION FEE.

GENERAL INFORMATION

1. The information on the attached affidavit is not co nfidential.

2. Any information contained on the attached affidavit may be verified by the judge or the

Kansas B oard of Indigents= Defense S ervices.

3. False entries may lead to criminal prosecution and conviction.

4. If you do not understand a specific question or need help, ask for assistance.

5. The judge may place you under oath and inquire further about any information provided

on this form.

ELIGIBILITY FOR DEFENSE SERVICES

1. Appointed counsel and other defense services will only by provided to people who cannot

afford to pay for these service s themselves.

2. If the judge determines that you are able to pa y a part of the co sts of your defense, you will

be found p artially indigent and the court will order yo u to pay for a part of these costs.

3. If, after the date o f the alleged offense, you tra nsfer any of your property for less than it is

worth, the State may sue to obtain repayment of the cost of your defense.

4. You must inform the court if there is a change in any of the financial information given on the

affidavit.

REPAYM ENT TO THE STATE

K.S.A. 1997 Supp. 21-4603 provides that persons who are convicted of a crime must reimburse the state general fund

for all or part of the attorney fees and expenses paid by the Ka nsas State Bo ard of Indigents= Defense Services. K.S.A. 1997

Supp. 21-4610 also provides that persons who are placed on probation or whose sentence is suspended must, as a condition of

probation, reimburse the state general fund for all or part of the attorney fees and expenses paid by the Kansas State Board of

Indigents= Defen se Services.

The cou rt shall take into account the financial reso urces and the nature of the b urden that pa yment of such sum will impose.

Any person who has been required to pay such sum and who is not willfully in default may petition the sentencing court to waive

paym ent of an y remaining ba lance or po rtion thereof.

I have read or have had read to me and understand the above notice. I hereby request that court-appointed counsel be

prov ided tom e and agree to attem pt to rep ay the State fo r the costs of my d efense if the court so order s.

________________________

__________________________________________

Date

Signature of D efendant

Application For Appointed Defense Services