Form Center

Step One

MUNICIPAL COURT
100 Perry Street, Castle Rock CO
80104
303.663.6123 - 303.336.6137
COURT@CRGOV.COM
APPLICATION FOR PUBLIC DEFENDER, COURT-APPOINTED COUNSEL
Pursuant to §21-1-103(3), C.R.S., a processing fee of $25.00 may be collected by the court upon final disposition of this case.
Case number:
Most serious charge:
Next hearing date/type:
It is important that you accurately complete all sections of this form as appropriate based on your personal circumstances. If a section does not apply, please write N/A.
Applicant
Applicant's employer
Name*
Employer's name
Mailing address*
Employer's mailing address
Street address (if different)
Street address (if different)
City, State, Zip*
Employer's City, State, Zip
Phone number*
Employer's phone number
Social Security Number*
Birthdate*
Position
Length of employment
Driver's license no.
State*
List the state where your driver's license was issued
Pay dates
Weekly, Biweekly, etc.
Pay rate/hours per week
Indicate rate hourly, daily, per week, per month or other
Continue

Step Two

Other household members (spouse, parent, etc.)
Other household member's employer
Name
Name
Relation to Applicant
Company
Mailing address
Mailing address
Street Address (if different)
Street address (if different)
City, State, Zip
City, State, Zip
Phone number
Phone number
Social Security Number
Birth date
Position
Length of employment
Driver's License No.
State
List the state where your driver's license was issued
Pay dates
Weekly, Biweekly, etc.
Pay rate/hours per week
Indicate rate hourly, daily, per week, per month or other
Marital status:
Total number of dependents (including yourself):
Continue |Go Back

Step Three

Gross monthly income
See definitions below for further information
Monthly expenses
See definitions below for further information
Self (wages, salary, commission)
Amount
Rent/mortgage
Amount
Spouse/other household members
Amount
Groceries
Amount
Parents (if same household)
Amount
Utilities
Amount
Unemployment Benefits
Amount
Clothing
Amount
Social Security/retirement funds
Amount
Maintenance/alimony and/or child support
Amount
Maintenance/alimony
Amount
Medical/dental
Amount
Other income (see below)
Amount
Other expenses (identify source)
Amount
Other income (see below)
Amount
Other expenses (identify source)
Amount
Total household income $
Total expenses $
A. Gross monthly income
Includes income from all members of the household who contribute monetarily to the common support of the household.
Income categories include: Wages, including tips, salaries, commission, payments received as an independent contractor for labor or services, bonuses, dividends, severance pay pensions, retirement benefits, royalties, interest/investment earnings, trust income, annuities, capital gains, unemployment benefits, Social Security Disability (SSD), Social Security Supplemental Income (SSI), Workman's Compensation Benefits, and alimony.
Note: Income from roommates should not be considered if such income is not commingled in accounts or otherwise combined with the applicant's income in a fashion which would allow the applicant proprietary rights to the roommate's income.
Income categories do not include: TANF payments, food stamps, subsidized housing assistance, veteran's benefits earned from a disability, child support payments, or other public assistance programs.
B. Expenses
Nonessential items such as cable television, club memberships, entertainment, dining out, alcohol, cigarettes, etc., shall not be included. Allowable expense categories are listed on JDF 208.
C. Liquid assets
Includes cash on hand or in accounts, stocks, bonds, certificates of deposit, equity, and personal property or investments which could readily be converted into cash without jeopardizing the applicant's ability to maintain home and employment.
Continue |Go Back

Step Four

Assets
Savings account balance $
Name of bank:
Checking account balance $
Name of bank:
Value of vehicles $
Year and model:
Value of recreational vehicles $
Year and model:
Value of house $
Amount owed $:
Value of other property $
Type:
Value of stocks, bonds, mutual funds $
Type:
Value of other investments $
Type:
Total assets $
Convertible to cash $
Continue |Go Back

Step Five

References
1. Name/address/phone
2. Name/address/phone

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
Submit | Go Back

Search Forms:

Application for Public Defender Court-Appointed Counsel

Steps

Step One

MUNICIPAL COURT

Step Two

Step Three

Step Four

Step Five

Contact Us

Connect With Us

Helpful Links