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REQUEST FOR COURT-APPOINTED ATTORNEY AND ORDER (MC 222)

  1. STATE OF MICHIGAN*
  2. THE PEOPLE OF THE STATE OF MICHIGAN
  3. V
  4. REQUEST
    The defendant requests a court-appointed attorney and submits the following information.
  5. SELECT ONE*
  6. Bail posted:*
  7. 2. RESIDENCE *
  8. 3. MARITAL STATUS *
  9. 4. Number of Dependents*
  10. Employer name and address
  11. Pay period*
  12. State value of car, home, bank deposits, inmate accounts, bonds, stocks, etc.
  13. Itemize monthly rent, installment payments, mortgage payments, child support, etc.
  14. 8. CONTRIBUTION TOWARD ATTORNEY COSTS
    I understand that I may be required to contribute to the cost of an attorney.
  15. Electronic Signature Agreement*
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  16. ORDER
  17. Name and Bar no.
  18. Form MC 222, Rev. 7/20
    MCR 6.005(B), MCR 6.610(D),(G)
  19. Leave This Blank:

  20. This field is not part of the form submission.