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Here is the text we could read:

THE PEOPLE OF

 The State of Michigan

 
 

Defendant’s name, address, and telephone no.

v

E-mail address

REQUEST

The defendant requests the appointment of an attorney and submits the following information:

1. CHECK ALL THAT APPLY
    
    
                                                                                                      substance abuse facility. 

 I am under the age of 18.                                                 
 I am currently serving a sentence in jail or prison.           

 I receive public assistance.
 I am receiving residential treatment in a mental health or 

 

 Felony 

 

 
 Paternity                                                                

3. RESIDENCE                                     
           
    

  Rent 

  Own 

          

  Live with relative(s)
  Room/Board

 Misdemeanor 

2. CHARGE 
 
    
  
    Next hearing: 

Date

    Bail amount: $ 
 
5. INCOME  Employer name and address

  

  

  Bond posted

4. MARITAL STATUS
  Single              
    
  Married          
    

  Divorced     
  Separated

  Dependents: 

 Number

Length of employment

Average take-home pay  $ 

 

    

  weekly             

  monthly           

  every two weeks

Other Income  State monthly amount and source (MDHHS, VA, rent, pensions, spouse, unemployment, etc.).
 

6. ASSETS*  State value of car, home, bank deposits, inmate accounts, bonds, stocks, etc.

7. OBLIGATIONS* 

Itemize monthly rent, installment payments, mortgage payments, child support, etc.

8. ATTORNEY COSTS
I understand that a decision will be made on whether I can afford an attorney. I understand that I may be required to 
contribute  to  the  cost  of  an  attorney.  I  understand  that  I  may  contest  my  ability  to  pay  any  ordered  costs  if  the  court 
attempts to collect any costs for an attorney, and the court must determine whether and how much, if any amount, I would 
be required to pay based on my ability to pay at that time. 

Date: 
 

                                              Signature: 
 

*Use other side for additional information/comments.

STATE OF MICHIGANJUDICIAL DISTRICTJUDICIAL CIRCUITREQUEST FOR APPOINTMENT OF ATTORNEY AND ORDERCASE NO. and JUDGEORIMI-Court addressCourt telephone no.Approved, SCAOForm MC 222, Rev. 12/21MCR 3.951, MCR 6.005, MCR 6.610(D),(G), MCR 6.625Page 1 of 2Distribute form to: Court                                                Appointed attorneyDefendant Appointing authorityRequest for Appointment of Attorney and Order 
Page 2 of 2

(12/21) 

Case No. 
 

 9.  The request is denied because:

ORDER

     appropriate.

    of an attorney.

 12. 

 

 

 

 10. The defendant is referred to the local appointing authority for indigency screening and appointment of an attorney, if 

 11. The defendant is financially unable to retain an attorney and is referred to the local appointing authority for appointment 

 Name                                                                                                                  Bar no.

     in this paternity action.                                                  

 is appointed to represent the defendant 

Judge signature and date

MC 222, Request for Appointment of Attorney and Order

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Michigan state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from www.courts.michigan.gov/criminal-felony-forms (2023-03)
Page(s): 2
Fields(s): 50
Average fields per page: 25
Reading Level: Grade 10
LIST Grouping(s): FA-00-00-00-00, CO-07-00-00-00, CO-00-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

name_address_telephone was Defendants name address and telephone no (0.61 conf)
undefined__1 was undefined_2 (0.39 conf)
users1_email was Email address (1.00 conf)
age was I am under the age of 18 (0.36 conf)
sentence_jail_prison was I am currently serving a sentence in jail or prison (0.40 conf)
receive_public_assistance was I receive public assistance (0.52 conf)
residential_mental_health was I am receiving residential treament in a mental health or (0.40 conf)
charge was 2 CHARGE (0.35 conf)
rent was Rent (0.43 conf)
own was Own (0.37 conf)
room_board was RoomBoard (0.35 conf)
live_relatives was Live with relatives (0.36 conf)
misdemeanor was Misdemeanor (0.45 conf)
felony was Felony (0.45 conf)
paternity was Paternity (0.38 conf)
next_hearing was Next hearing (0.35 conf)
single was Single (0.32 conf)
divorced was Divorced (0.44 conf)
dependents was Dependents (0.41 conf)
number was Number (0.38 conf)
bail_amount was Bail amount (0.35 conf)
married was Married (0.36 conf)
separated was Separated (0.31 conf)
bond_posted was Bond posted (0.35 conf)
undefined__2 was undefined_3 (0.39 conf)
weekly was weekly (0.28 conf)
monthly was monthly (0.28 conf)
every_two_weeks was every two weeks (0.36 conf)
income_state_pensions_unemployment was Other Income State monthly amount and source MDHHS VA rent pensions spouse unemployment etc (0.47 conf)
asset_state_home_accounts was 6 ASSETS State value of car home bank deposits inmate accounts bonds stocks etc (0.48 conf)
monthly_payments_mortgage was 7 OBLIGATIONS Itemize monthly rent installment payments mortgage payments child support etc (0.45 conf)
signature_date was Date (1.00 conf)
circuit was Circuit (0.33 conf)
district was District (0.24 conf)
judge was Judge (0.39 conf)
court_telephone was Court telephone no (0.51 conf)
mi was ORI MI (0.45 conf)
court_address was Court address (0.42 conf)
state_michigan was The State of Michigan (0.46 conf)
checkbox was checkbox1 (0.35 conf)
text__1 was Text6 (0.35 conf)
text__2 was Text7 (0.35 conf)
text__3 was Text8 (0.35 conf)
request_denied was 9 The request is denied because (0.37 conf)
defendant_authority_screening was 10 The defendant is referred to the local appointing authority for indigency screening and appointment of an attorney if (0.41 conf)
defendant_unable_authority was 11 The defendant is financially unable to retain an attorney and is referred to the local appointing authority for appointment (0.34 conf)
unknown was 12 (0.38 conf)
bar was Bar no (0.41 conf)
users1_name was Name (1.00 conf)
box was #9 BOX (0.24 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

MC 222, Request for Appointment of Attorney and Order

About This Form:

Identified Data Fields:

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02