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Complete this form if you are requesting the court to appoint an attorney in a pending criminal case filed in the Bainbridge Is. Municipal Court. The named Defendant should complete this form. Do not complete this form for someone else unless that person needs assistance due to disability.
This online form is offered for convenience. The answers will be submitted to the court email address, which will be provided to the Judge at the next hearing.
If you prefer to complete a paper form and submit that to the court via email, fax, or in-person, the form is available on the court website: Court Forms & Resources | Bainbridge Island, WA - Official Website (bainbridgewa.gov)
If there is a question that does not apply to you, you may list N/A or none.
You are submitting this document as a declaration under penalty of perjury. By completing this form, you understand that the court may require verification of the information provided.
Check all that apply
Include all forms of income from jobs, unemployment, social security, pension, or worker's compensation.
Any answer other than YES will result in you NOT being considered by the court for appointment of an attorney.
This field is not part of the form submission.
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