100 Perry Street, Castle Rock CO
303.663.6123 - 303.336.6137
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.
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.
List the state where your driver's license was issued
Weekly, Biweekly, etc.
Indicate rate hourly, daily, per week, per month or other
See definitions below for further information
Self (wages, salary, commission)
Spouse/other household members
Parents (if same household)
Social Security/retirement funds
Maintenance/alimony and/or child support
Other income (see below)
Other expenses (identify source)
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.
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.
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.
This field is not part of the form submission.
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