Rule 26.2 Application For and Appointment of Counsel

When an accused person, contending to be financially unable to employ an attorney to defend against pending criminal charges or to appeal a conviction, desires to have an attorney appointed, the accused shall make a request in the form of an application for appointment of counsel and certificate of financial resources, made under oath and signed by the accused. This form shall contain information as to the accused's assets, liabilities, employment, earnings, other income, number and ages of dependents, the charges against the accused and such other information as shall be required by the court. The purpose of the application and certification is to provide the court or its designee with sufficient information from which to determine the financial ability of the accused to employ counsel. Upon a determination of indigency the court shall, in writing, authorize the appointment of counsel for the indigent accused. The original authorization of appointment shall be filed with the clerk of court; a copy of the authorization shall be forwarded to the clerk, court administrator, public defender or such other person designated by the court to assign an attorney to an indigent defendant. Such person shall notify the accused, the appointed attorney, the sheriff and the prosecuting attorney of the appointment. The application for an attorney and certificate of financial resources shall be in substantially the following form:

IN THE MAGISTRATE COURT OF ______ COUNTY STATE OF GEORGIA STATE OF GEORGIA (CASE NO.)

CHARGE(S):

v. _____________ APPLICATION FOR APPOINTMENT OF COUNSEL AND CERTIFICATE OF FINANCIAL RESOURCES I am the defendant in the above-styled action. I cannot afford to hire a lawyer to assist me. I want the court to provide me with a lawyer. I understand that I am providing the following information in order for the court to determine my eligibility for a court-appointed lawyer to defend me on the above charges.

In jail ____ Out on bond ____ Arrest Date ___________

1. Name _________________________________ Telephone No. _____________________ Mailing address ________________________________________________________ Birth date ______ Age ____ Soc. Sec. No. _______________________________ Highest grade in school completed ______________________________________

2. If employed, employer is _________ . My take home pay is ____________

3. If unemployed, how long? ________ List other sources of income such as unemployment compensation, welfare or disability income and the amounts received per week or month: _____________________________________________________________________________

4. Are you married ______ Is spouse employed? __________________________ If yes, by whom ____________ Spouse's net income ____________ (week)

5. Number of children living in home: ______ Ages ______________________

6. Dependents (other than spouse or children) in home, names, relationship, amount contributed to their support ___________________________

7. Do you own a motor vehicle? Year and model ______________ How much do you owe on it? _____________________________________________

8. Do you own a home? ____ Value ______ How much do you owe on it?__________________

9. Amount of house payment or rent payment each month __________________

10. List checking or savings accounts or other deposits with any bank or financial institution and the amount of deposits:_______________________________________________________

11. List other assets or property, including real estate, jewelry, notes, bonds or stocks ______________________________________________________

12. List indebtedness and amount of payments ___________________________

13. List any extraordinary living expenses and amount (such as regularly occurring medical expenses) _________________________________________________

14. Child support payable under any court order ________________________

15. Do you understand that whether you are convicted or acquitted _____________ County may seek reimbursement of attorney's fees paid for you if you become financially able to pay or reimburse the county but refuse to do so?_____________ I have read (had read to me) the above questions and answers and they are correct and true.

The undersigned swears that the information given herein is true and correct and understands that a false answer to any item may result in a charge of perjury.

The ______ day of ____________, 20_. __________________________ Defendant's Signature Sworn to and subscribed before me this ______ day of ____________, 20_. __________________________ Notary Public My Commission Expires ______ ORDER Having considered the above matter, it is the finding of this court that the above-named defendant is/is not indigent under criteria of the Georgia Criminal Justice Act and appropriate court rules and is/is not entitled to have appointed counsel.

It is ordered that the clerk, panel administrator, or court administrator assign an attorney practicing in this county to represent the defendant in the above case.

Let the defendant and the assigned attorney be notified hereof and furnished a copy of this application and order. This ______ day of ____________, 20_. ___________________ Magistrate Court Judge __________ County