Name: _______________________________________________________________
Address: ____________________________________________________
Contacts: Office: ________________ Fax: _____________ Cell: _______________________
Email: ____________________________________ Home: ___________________
EXPERIENCE
I have read the
Qualifications, Regulations and Standards of the Public Defender Commission (which are
available on-line at www.hamilton-co.org/pub_def/default.htm) and hereby certify that I was admitted to the
Bar in ____________ and have practiced Criminal Law for ________ years. During the course of my legal career, I
obtained the following experience in:
(A) Aggravated Murder with Death Penalty Specifications:
I meet the qualification set forth in Rule 20 of the Ohio Supreme Court
“Appointment of Counsel for Indigent Defendants in Capital Cases”
and I am on the list of attorneys qualified as:
(1) lead counsel ___ (2)
Co-counsel ___ (3) Appellate ___
|
(B) Other Homicides: |
__ |
|
||
|
|
__ |
(2) Trial counsel in two first-degree felony or aggravated felony trials |
||
|
|
__ |
(3) Trial counsel in ten or more jury trials |
||
|
(C) Felony, 1– 3 Degree: |
__ |
(1) Trial counsel in two or more first, second or third degree felony trials, at least one of which was a jury trial; or |
||
|
|
__ |
(2) Trial counsel in any four jury trials at least one of which was a jury trial in a first, second or third degree felony; or |
||
|
|
__ |
(3) Trial counsel in any two criminal trials and: (i) Co-counsel in at least
one criminal jury trial; (ii)Trial counsel or co-counsel in two jury trials. |
|
(D) Felony, 4 and 5 Degree: |
__ |
(1) Prior experience as trial counsel or co-counsel
in at least one jury trial; or |
|
|
__ |
(2) Prior completion of a training program on
criminal practice or procedure which is certified for continuing legal
education credit by the Ohio Supreme Court Commission on continuing legal
education. QUALIFICATIONS |
1) Based upon
the foregoing I believe that I am qualified and should be categorized to
include the following classifications:
Please
circle: (A) Agg.
Murder with Specs. Lead counsel and/or Co-Counsel; (B)
Other Homicides; (C)
Felonies: 1-3;
(D)
Felonies 4-5; (E) Misdemeanors; (F)Delinquency; (G) Dependency; (H) Guardian Ad Litem; (I) Appeals
2) I do do not
(please check one) want to be included on a felony panel or a contract attorney
for misdemeanors. I agree to be available ____ day(s) a week or ____ day(s) a month and I would prefer __________________________________(specify
day(s)).
3) I am available on an ON-CALL
basis for Room A assignments. Please check one: yes no.
4) I agree to
notify the Public Defender Commission in writing of any change in my personal
or professional status that would affect my
qualifications to serve as appointed counsel.
5) Further, I
understand and agree that if I am assigned a case wherein the Grand Jury
returns an indictment and the indictment
has raised the level of the case to a status that exceeds
my qualifications I will report said fact to the Office of the Public Defender
and request assistance.
Please check: I
agree__________.
6) Pursuant to
Regulation II (5) Insurance Compliance:
Carrier________________________________
Policy no. ______________
7) I understand that vouchers are to be submitted
within 30 days of case termination and that each voucher must be
accompanied by an executed affidavit of indigency in order to receive payment.
Failure to submit the voucher in timely fashion will result in a 50% reduction
in the fee.
_________________________________ _________________________________
(Signature) (Approval) (date)
This registration form is to be used when seeking to
change current registration status and /or current information such as address,
e-mail address or phone number.
Please complete the following contact information ONLY
if there has been a change.
Contacts: Office: ________________ Fax: _____________ Cell: _______________________ Email: ____________________________________ Home: ___________________
EXPERIENCE
I am currently a member of the Public
Defender’s panel and I am qualified and categorized to represent defendants in:
Please
circle: (A) Agg.
Murder with Specs. Lead counsel and/or Co-Counsel; (B) Other
Homicides; (C) Felonies: 1-3
(D)Felonies 4-5;
(E) Misdemeanors; (F)
Delinquency; (G) Dependency; (H) Guardian Ad Litem; (I) Appeals
During the past year I attended various seminars and/or represented various defendants, which I believe warrants my
re-categorization. Please list the seminars attended and any cases involved in. Please note the seminars sponsor and the case name(s), case number(s), degree of the offense(s). Prosecutor(s), and trial Judge(s). __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
QUALIFICATIONS
1) Based upon the foregoing I believe that I am qualified and should be re-categorized to include the following classifications.
Please
circle ONLY those areas that
you wish to add to your categorization list.
(A) Agg. Murder with Specs. Lead
counsel and/or Co-Counsel;
(B) Other Homicides;
(C) Felonies: 1-3;
(D) Felonies 4-5 (E) Misdemeanors; (F) Delinquency; (G) Dependency; (H) Guardian Ad Litem; (I) Appeals
2 ) I do do not (please check one) want to be included on a felony panel or a contract attorney for misdemeanors. I agree to be available ____ day(s) a week or ____ day(s) a month and I would prefer ______________________________(specify day(s)).
3) I am available on an ON-CALL
basis for Room A assignments. Please check one: yes no.
4) I agree to
notify the Public Defender Commission in writing of any change in my personal
or professional status that would affect my qualifications to serve as
appointed counsel.
5) Further, I
understand and agree that if I am assigned a case wherein the Grand Jury returns
an indictment and the indictment has
raised the level of the case to a status that exceeds my
qualifications I will report said fact tot the Office of the Public Defender
and
request assistance. Please check: I agree_________.
6) I understand
that vouchers are to be submitted within 30 days of case termination and
that each voucher must be accompanied by an executed affidavit of indigency in order to receive payment. Failure to submit
the voucher in timely fashion will result in a 50% reduction in the fee.
_________________________________ _________________________________
(Signature) (Approval) (date)