Free Application For Approval As Indigent Criminal Defense Counsel - Ohio

APPENDIX J (L.R. 5.04, fka 5.01B) APPLICATION FOR APPROVAL AS INDIGENT CRIMINAL DEFENSE COUNSEL BUTLER COUNTY COMMON PLEAS COURT Name_______________________________________________________________________ Butler County Business Address__________________________________________________ ____________________________________________________________________________ (Location where you intend to confer with your clients; not a P.O. Box) Preferred Mailing Address_______________________________________________________ ____________________________________________________________________________ Phone_______________________Fax___________________Cell_______________________ E-mail______________________________ Attorney Registration # _____________________ Preferred contact individual (for case assignments) and individual's phone ____________________________________________________________________________

List any formal post-law school training for criminal representation (including seminars). Include the year in which the formal training took place:

List any professional associations affiliated with, with regards to criminal defense:

Estimate the number of criminal defendants, along with the types of offenses, you have represented (we recognize that for some of you, this will be a very rough estimate). State if case went to evidentiary hearing (motion, court or jury trial, etc):

Do you have Supreme Court certification for capital cases? _____Yes_____No Dates and location of training____________________________________________________ ____________________________________________________________________________ What do you feel are your biggest strengths with regards to criminal defense?

What areas do you feel could use improvement with regards to your criminal defense abilities and what will you do to make those improvements?

Do you have current legal malpractice insurance? List company, policy number and expiration date of the policy. (Attach proof of insurance.)

Are you currently a member of the Butler County Bar Association? membership card.)

(Attach copy of Bar

Signature______________________________________________________________________ Return completed application to: Manager of Court Administrative Services Butler County Common Pleas Court Government Services Center, Third Floor 315 High Street Hamilton, Ohio 45011