DISTRICT COURT OF MARYLAND FOR
Located at
Court Address

City/County

Case No.
vs.
Defendant

STATE OF MARYLAND

PETITION FOR DETERMINATION OF ELIGIBILITY FOR COUNSEL
(Rule 4-202) and (Article 27A § 6(f)) I am a defendant in the above captioned criminal case: On at and requested the appointment of counsel, which request was denied for the following reasons: ,
Year

, I reported to the office of the Public Defender

My scheduled trial date on the charges of

is

Date

.

I do not agree with the initial determination of the Public Defender for the following reasons:

I am enclosing a fully completed copy of Petition for Waiver of Costs (CC-DC 8) setting forth my assets and liabilities.

Name Address

Telephone

DC/CR 33 (Rev. 6/2003)