Rule 29.3. The Role of Law Enforcement

Any law enforcement authority having custody of any person shall:

(A) Allow a person claiming to be indigent and without counsel to immediately complete an application for an attorney and certificate of financial resources and forward such to the court or its designee, for a determination of indigency or not;

(B) Clearly advise detained persons of their right to have counsel and that if they cannot afford a lawyer one will be provided to assist them;

(C) Accomplish the above procedures as soon as possible after detention; and,

(D) Complete an application for an attorney and certificate of financial resources in substantially the following form: IN THE SUPERIOR COURT OF ____ COUNTY STATE OF GEORGIA STATE OF GEORGIA INDICTMENT NO. v. CHARGE(S): ___________________ APPLICATION FOR APPOINTMENT OF COUNSEL AND CERTIFICATE OF FINANCIAL RESOURCES I am the defendant in the above-styled action.

I am charged with the offense(s) of ________________ which is/are a felony/misdemeanor.

I can/cannot afford to hire a lawyer to assist me.

I do/do not want the court to provide me with a lawyer.

I understand that I am providing this information in this declaration in order for the court to determine my eligibility for a court-appointed lawyer, paid by ________ County, to defend me on the above charges. In jail ________ Out on bond ________ Arrest Date _______ 1. Name ______________ Telephone No. _______________________ Mailing address ____________________________________________ Birth date _______ Age _____ Soc. Sec. No. _________________ Highest grade in school completed ___________________________ 2. If employed, employer is _________________________________ Net take home pay is (gross pay minus state, federal and social security taxes): ________ (weekly) ________ (monthly) 3. If unemployed, how long? __________ List other sources of income such as unemployment compensation, welfare or disability income and the amounts received per week or month:________________. 4. Are you married ______ Is spouse employed? _____________________ If yes, by whom _________ Spouse's net income (week) _______________ 5. Number of children living in home: __________ Ages __________ 6. Dependents (other than spouse or children) in home, names, relationship, amount contributed to their support ______________________ 7. Do you own a motor vehicle? ____ Year and model __________ How much do you owe on it? ______________________________ 8. Do you own a home? _______ Value ________How much do you owe on it? __________ 9. Amount of house payment or rent payment each month _____________ 10. List checking or savings accounts or other deposits with any bank or financial institution and the amount of deposits: _________________________________________________________________________ 11. List other assets or property, including real estate, jewelry, notes, bonds or stocks _________________________________________________________________________ 12. List indebtedness and amount of payments _________________________________________________________________________ 13. List any extraordinary living expenses and amount (such as regularly occurring medical expenses) __________________________________________________________________ 14. Child support payable under any court order _____________________ 15. Do you understand that whether you are convicted or acquitted ______ County may seek reimbursement of attorney's fees paid for you if you become financially able to pay or reimburse the county but refuse to do so? ____________________________ I have read (had read to me) the above questions and answers and they are correct and true. The undersigned swears that the information given herein is true and correct and understands that a false answer to any item may result in a charge of perjury. The ______ day of _______, 20. _________________________ Defendant's Signature Sworn to and subscribed before me this ______ day of __________, 20. __________________________________ Notary Public My Commission Expires _______ ORDER Having considered the above matter, it is the finding of this court that the above-named defendant is/is not indigent under criteria of the Georgia Criminal Justice Act and appropriate court rules and is/is not entitled to have appointed counsel. It is ordered that the clerk, panel administrator, or court administrator assign an attorney practicing in this county to represent the defendant in the above case. Let the defendant and the assigned attorney be notified hereof and furnished a copy of this application and order. This ______ day of _________, 20. ______________________ Superior Court Judge _________ Judicial Circuit