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Application for Public Defender

  1. Check the boxes next to any of the following types of assistance you receive:
  2. Do you work or have a job?*
  3. Do you have a spouse or partner that lives with you?*
  4. Do you and/or your spouse/partner receive unemployment, Social Security, a pension, or workers compensation?*
  5. Please complete all that apply:
  6. Do you and/or your spouse/partner have children residing with you? *
  7. Do you own a home? *
  8. Do you own a vehicle? *
  9. Other than routine living expenses such as rent, utilities, food, etc. do you have any other expenses such as child support payments, court-ordered fines, or medical bills, etc.? *
  10. Do you have money available to hire a private attorney? *
  11. I certify under penalty of perjury under Washington State law that the above is true and correct. I give my permission for the court designated agency to verify this information and I authorize all persons listed above to release my financial information to the Gig Harbor Municipal Court, and I agree to hold them harmless for such release. I also agree to immediately report any change in my financial status to the court.*
  12. Electronic Signature Agreement*
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  13. Leave This Blank:

  14. This field is not part of the form submission.