Application to Serve as Assigned Counsel

Contact Information

Name *

Business Address *

Email Address *

Business Phone *

Cell Phone

Registration

Admitted to Ohio Bar *

Registration Number *

Certifications

I have read the qualifications and I qualify for inclusion on the

Lead Counsel: APPT. COUN. R. 3.02/Death Penalty

Co-Counsel: APPT. Coun. R. 3.03/Death Penalty

Life Sentence

Felony 1st/2nd Degree without life sentences

Felony 3rd Degree without life sentences

Felony 4th/5th Degree and unspecified felonies other than murder

OVI Felony

Mental Health Docket

Probation Violation Hearing

Cases

In that I have served as trial counsel in the following cases, which were tried, to verdict. (Please include Docket No, Name, Highest Charge, Date of Trial, and Judge for each case.)

Case 1

Case 2

Case 3

Case 4

Case 5

Attachment: Proof of Insurance

Attachment: Most Recent CLE Transcript For Criminal Practice and Procedure

Confirmation

I hereby state that the facts contained above are true.

As a consideration of being on this list, I will comply with the compensation schedule as enumerated in Rule 33.

If you have any questions, please call 216-443-8563.

Common Pleas Court
General Division
Cuyahoga County

1200 Ontario Street · Cleveland, Ohio 44113

(216) 443-8560

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