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`THE STATE OF TEXAS
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`IN THE COUNTY CRIMINAL
`COURT AT LAW NO.
`HARRIS COUNTY, TEXAS
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`5
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`RE UEST AN ORDER FOR APPOINTMENT OR WAIVER OF COUNSEL
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`S .1 am C! the defendant D a witness in this case. Today thejudge presiding advised me ofmy
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`My name is
`right to be representedbya lager, eitherone thatIhire or ifIam indigentorthe interests ofjustice require, a lawyerappointedby thejudgeas
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`well as the procedurefor making this request; and the right to represent myself
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`CI I believe that] am indigent and I am requesting the Court appoint counsel to represent me. I understand that ifthere is a material change in my
`financial circumstances after a determination of my indigence is made, that I, my counsel, or the Assistant District Attorney representing the
`State may ask the judge to reconsider the judge ’s decision. In support of this request I am giving sworn testimony before the judge about my
`personal andfinancial circumstances. I understand this information may not be usedfor any purpose except to determine my indigency or to
`impeach anyfuture testimony I may give in this case.
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`I received assistance in completing this requestfrom
`El a court services ofiicer, El a court clerk,
`CI other MI(LL.
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`nsel and1 choose to waive counsel and represent
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`CI I understand my right to counsel and the pro:‘
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`Signature ofDefendant:
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`Sworn to before me on
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`ORDERQE ARNIINING RIGHTTfiAPPOINTMENfiFwO NS:ng«$06 :6)
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`es counsel was heardin o!
`and evidence presented co
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`resources.
`Today Defendant's request for app
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`The Court FURTHER :_
`The Court APPOINTS the
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`1
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`CI Attorney
`CI Public Defender
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`named below to represent De
`firm. d, the defen- .
`the attorney is relieved ofhis d hit-Ehytheco'nrt or reggcedby other counsel
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`Attorney
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`SPN/State Bar# 251'
`Address
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`City
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`The Court FINDS Defendant has the financial resources to employ counsel and. the appointment of counsel in the interests of justice is not
`necessary; accordingly, the request is DENIED. The Court immediately advised Defendant of the right to a reasonable opportunity to hire a
`lawyer, or that Defendant could waive that right and speak with a prosecutor immediately after this hearing.
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`CI Defendant knowingly and voluntarily waived a reasonable opportunity to hire a lawyer and afier reading the following, and having it
`explained to him by the Court, sign his name. I have been advised by thejudge ofmy right to representation by counsel in the case pending
`against me. I have been fixrther advised that if] am unable to aflord counsel, one will be appointedfor me fi'ee of charge. Understanding
`my right to have counsel appointedfor me free of charge if I am not financially able to employ counsel, I wish to waive that right and
`request the court to proceed with my case without an attorney being appointedfor me. I hereby waive my right to counsel.
`Date:
`Defendant Signature:
`CI Defendant refused to sign the w'
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`Thereafter, 1 informed Def- - - -t o I: e n > of the charge contained in the information and permitted him to speak with a prosecutor.
`CI Defendant's request for a -asonable opportunity to hire a lawyer was GRANTED.
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`Judge Presiding:
`CCL Form 3
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`Date Signed:
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`fi 12 fl
`v
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`05-13-2011
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`CLERK
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