Adams Public Defender Application Form PDF Details

Filling out the Adams County Public Defender Application is a critical step for those facing legal challenges and seeking representation without the means to afford private counsel. The form requires a wealth of information, including personal details like your name, date of birth, social security number, and contact information, as well as specific details pertaining to your legal situation such as case number, charges, and any pending charges. It also inquires about your financial situation, asking for employment status, income details, and whether you're receiving any form of government assistance or have savings accounts. Notably, the application demands complete honesty, as you must disclose your marital status, if you're on probation or parole, and provide detailed information about any prior criminal record. The stipulation that delays may result from illegible information underscores the importance of clarity and thoroughness in filling out the form. Additionally, the form includes sections where you can indicate the need for an interpreter and the languages spoken, demonstrating an awareness of and sensitivity to the diverse needs of applicants. With sections on upcoming court dates and proceedings, the application is comprehensive, designed to gather all necessary data to assess eligibility for a public defender. This meticulous approach ensures that those in need are provided with legal representation, highlighting the justice system's efforts to maintain fairness and accessibility.

QuestionAnswer
Form NameAdams Public Defender Application Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesMagisterial, SSD, PENNSYLVANIA, adams public defender application

Form Preview Example

Date of Application:

Case Number:

ADAMS COUNTY PUBLIC DEFENDER APPLICATION

Please print and fill in the application completely. delays will result if information is not legible. If you receive any other new charges, you must re-apply for every charge. Please bring all of your legal paperwork and most recent 3 pay stubs with you.

Last Name:

 

 

First Name:

 

Middle Name:

Alias:

 

 

 

 

 

 

 

Date of Birth:

 

 

 

 

 

Driver's License #:

 

 

 

Driver's License State:

Social Security #:

Mailing Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City:

 

 

 

 

 

 

 

State:

 

 

Zip Code:

 

Phone # (home):

 

 

 

 

 

 

 

(cell):

 

 

 

 

 

 

Interpreter Needed:

Yes

No

Language:

 

 

 

 

 

 

Please place a check next to all that apply:

you are here for:

 

 

 

 

 

Criminal Charges

 

 

 

Parole/Probation/IPP Violation

 

Appeal Issues

 

 

 

 

 

 

 

 

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

What are your charges:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Who else was involved:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Magisterial District Judge:

 

 

 

 

 

 

 

 

 

 

 

 

Current bail amount for all charges:

 

 

 

 

 

Next Court Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

Time:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type (Check one):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Preliminary Hearing

 

Waived Preliminary Hearing

 

Arraignement

 

 

Pre-Trial Conference

Plea

Trial

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Do you have any other pending charges:

 

 

 

 

 

Yes

 

 

 

 

No

 

Charges:

 

 

 

 

 

 

If Yes, please explain and name your attorney:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Do you have a prior adult criminal record:

 

 

 

 

 

Yes

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Are you presently on probation or parole:

 

 

 

 

 

Yes

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Marital Status:

 

 

 

 

 

 

 

 

 

 

 

 

Number for Children:

 

 

 

 

 

 

 

 

Ages:

 

 

 

 

 

Are you a US Citzen:

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Are you currently employed:

 

Yes

 

 

 

 

 

No

 

 

 

Where:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Weekly Net Pay:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Savings/Checking account balance:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Do you receive SSI/SSD:

Yes

 

 

 

 

No

 

Monthly amount:

 

 

 

 

 

 

 

 

 

 

 

 

Does your Spouse/live-In/Significant Other work:

 

 

 

Yes

 

No

 

Where:

 

 

 

 

 

 

His or Her Savings/Checking account balance:

 

 

 

 

 

 

 

 

 

 

 

 

SSI/SSD:

 

 

 

 

 

 

Does anyone in household currently receive:

 

 

 

 

 

Welfare

 

Unemployment

Other

 

Amount:

 

 

 

 

 

 

 

 

 

 

 

 

How often:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Real Estate Owned:

 

 

 

 

 

 

 

 

 

Valued:

 

 

 

 

 

 

Mortgage Balance:

 

 

is there anybody with whom we have your permission to speak with regarding your case:

 

 

 

Yes

No

If yes, what is their name and relation to you:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Do we have permission to speak to the:

 

 

District Attorney

 

Assistant District Attorney

 

 

Prosecuting Officer or

District Judge regarding your case prior to our first appearance on your behalf:

THE COURT OF COMMON PLEAS OF ADAMS COUNTY, PENNSYLVANIA

CRIMINAL

COMMONWEALTH OF PENNSYLVANIA

Criminal Action

Vs.

Case No.

 

 

ALL QUESTIONS MUST BE ANSWERED AND THE AFFIDAVIT COMPLETED BEFORE THE COURT WILL ACT ON THE PETITION.

COMMONWEALTH OF PENNSYLVANIA

: SS.

COUNTY OF ADAMS

:

……………………………………………………………………………………., being duly sworn according to

law, upon (his) (her) oath, deposes and says:

1.I am the petitioner in the above entitled action.

2.I have read the foregoing petition and know the contents thereof and the same are TRUE to my own knowledge, except as to matters therein stated to be alleged as to persons other than myself, and, as to those matters I believe it to be true.

3.This affidavit is made to inform the Court as to my status of indigence and to induce the Court to assign counsel to me as an indigent defendant for my defense against the criminal charges that have been made against me.

4.In making this affidavit I am aware that PERJURY is a felony and that the punishment is a fine of not more than $15,000 or imprisonment for not more than seven years or both.

5.I understand that I must advise the Court immediately of any material change in my financial circumstances such as but not limited to, and increase of wages or new employment.

Signature of Defendant

FOR OFFICE USE ONLY

INTERVIEWER'S NOTES:

PRELIMINARY HEARING

 

 

 

 

 

ARRAIGNMENT

 

 

 

PRE-TRIAL CONFERENCE

 

PLEA

 

 

 

TRIAL TERM

 

IPP VIOLATION

 

 

 

 

 

 

PROBATION/PAROLE VIOLATION

 

 

 

PFA CONTEMPT

 

 

 

 

 

 

SUMMARY

 

 

 

 

 

 

RULE 456

 

 

 

 

 

 

BAIL REDUCTION

 

 

 

 

 

 

SUPERVISED BAIL

 

 

 

 

 

 

SEND STENO

Yes

No

APPEAL

 

 

 

 

 

 

PCRA

 

 

 

 

 

 

Notes

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This document will involve specific information; to ensure accuracy and reliability, please heed the recommendations further on:

1. You need to complete the SSI correctly, thus be attentive when filling in the parts comprising all of these fields:

Part no. 1 of filling in adams county public defender application

2. The next part would be to fill out these blanks: Other, What are your charges, Who else was involved, Magisterial District Judge, Next Court Date, Type Check one, Current bail amount for all charges, Time, Preliminary Hearing, Waived Preliminary Hearing, Arraignement, PreTrial Conference, Plea, Trial, and Do you have any other pending.

adams county public defender application conclusion process shown (part 2)

3. Completing Does your SpouseliveInSignificant, His or Her SavingsChecking account, Yes, Where, SSISSD, Does anyone in household currently, Welfare, Unemployment, Other, Amount, Real Estate Owned, How often, Valued, Mortgage Balance, and is there anybody with whom we have is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Does your SpouseliveInSignificant, is there anybody with whom we have, and Mortgage Balance in adams county public defender application

4. Filling out COMMONWEALTH OF PENNSYLVANIA, Criminal Action, Case No, ALL QUESTIONS MUST BE ANSWERED AND, COMMONWEALTH OF PENNSYLVANIA, SS , I am the petitioner in the above, I have read the foregoing petition, my own knowledge except as to, and This affidavit is made to inform is paramount in the fourth section - always be patient and fill out each blank area!

Criminal Action, ALL QUESTIONS MUST BE ANSWERED AND, and I am the petitioner in the above inside adams county public defender application

Always be extremely careful while filling in Criminal Action and ALL QUESTIONS MUST BE ANSWERED AND, since this is where a lot of people make some mistakes.

5. When you approach the end of the document, there are actually just a few more points to do. Notably, Signature of Defendant must be done.

adams county public defender application completion process explained (portion 5)

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