In the matter of 

First and last name(s), alias(es)

WAIVER OF ATTORNEY

1. 
 
 
 
 
 
 

Date

 I am the respondent and I understand I have the right to be represented by an attorney at all hearings in the family 
    division of the circuit court. If I cannot afford an attorney, an attorney will be appointed to represent me. Knowing this, 
    I freely waive the right to the assistance of an attorney.

 I am a juvenile and I understand I have the right to be represented by an attorney at all hearings in the family division 

    of the circuit court. If I or the person responsible for my support cannot afford an attorney or refuses or neglects to 
    retain an attorney for me, an attorney will be appointed to represent me. Knowing this, I freely waive the right to 
    the assistance of an attorney.

 

Juvenile/Respondent signature

 2. The parent, guardian, legal custodian, or guardian ad litem of the 
    object to the above waiver of the assistance of an attorney.

 

 

 juvenile 

 

 minor respondent 

  did not 

3. I have explained the right to the assistance of an attorney as provided by law and court rule and am satisfied that the 
  above waiver is voluntarily and understandingly made. I accept the waiver.

 

                     

Judge/Referee signature and date

REQUEST FOR APPOINTMENT OF ATTORNEY

 4. I declare that I am unable to pay fully for the services of an attorney and request that an attorney be appointed to 
    represent me. I understand that I may be responsible for paying the costs of an appointed attorney after my ability to 
    pay has been determined and that when an attorney is appointed for a juvenile, that the court may assess some or 
    all of the costs against the persons responsible for the support of the juvenile. I authorize the court to investigate and 
    obtain relevant information from my employer, creditors, and others who have knowledge of my financial circumstances 
    for purposes of determining my eligibility for the appointment of an attorney.

 
 
 
 
 

Juvenile signature                                                                                 Date

Parent/Guardian/Legal custodian/Respondent                                         Date

Name (type or print)

Address

 

 

 

 

Name (type or print)

Address

City, state, zip                                                                        Telephone no.

City, state, zip                                                                            Telephone no.

ate

 D

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

 

5. Witnessed by: 

Name

Approved, SCAO
Form JC 06, Rev. 12/21
MCL 712A.17c(8), MCR 3.915, MCR 3.935(B)(4), MCR 3.942(B)(3), 
MCR 3.944(B)(4), (C)(1)(b), MCR 3.946(C)(2), MCR 3.951, 
MCR 3.985(B)(3), MCR 3.987(C)(3)
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STATE OF MICHIGANJUDICIAL CIRCUIT - FAMILY DIVISIONCOUNTYWAIVER OF ATTORNEY OR REQUEST FORAPPOINTMENT OF ATTORNEYCASE NO.PETITION NO.JUDGECourt addressCourt telephone no.JIS Code: WAA, RAA