ACCEPTED 06-15-00112-CR SIXTH COURT OF APPEALS TEXARKANA, TEXAS 7/24/2015 3:27:43 PM Appellate Docket Number. 06-15-00112-CR DEBBIE AUTREY CLERK Appellate Case Style: Style: '.Jerome Lydale Anderson
Vs. State of Texas
FILED IN Companion Case: I I 6th COURT OF APPEALS TEXARKANA, TEXAS 7/24/2015 3:27:43 PM DEBBIE AUTREY Clerk Amended/corrected statement: D DOCKETING STATEMENT (Criminal) Appellate Court: 6th Court of Appeals (to be filed in the court of appeals upon perfection of appeal under TRAP 32)
L Appellant Il. Appellant Attomey(s)
First Name: Jerome I ~ Lead Attorney
Middle Name: Ly dale I First Name: Robert i Last Name: Anderson I Middle Name: Lee I I Suffix: Last Name: Cole I Appellant Incarcerated? [gJ Yes D No Suffix: Jr. Amount of Bond: ~Appointed D District/County Attorney 0Retained D Public Defender Pro Se: 0 Firm Name: Law Office of Robert Cole I Address 1: 409 N. Fredonia, Suite 101 I Address 2: J City: Longview j State: Texas Zip+4: 75601 Telephone: 903-236-6288 ext t l Fax: 903-236-5441 I
Email: rcolejd@gmail.com .I SBN: 04547800 i IAdd Another Appellan4 Attorney
Page I of5 ID. Appellee IV. Appellee Attomey(s)
First Name: State of Texas [gl Lead Attorney Middle Name: First Name: Coke
Last Name: Middle Name: Ward Suffix: Last Name: Solomon Appellee Incarcerated? D Yes ~ No Suffix:
Amount of Bond: D Appointed ~ District/County Attorney Pro Se: 0 0Retained D Public Defender Firm Name: Harrison County District Attorney Office Address I : 200 W. Houston Street, 2d Floor Address 2: City: Marshall State: Texas Zip+4: 7567o-4027 Telephone: 903-935-8408 ext. Fax: 903-938-9312 Email: cokec@co.harrison.tx.us Add Another Appeilee/ SBN: 24041954 Attorney
V. Perfection Of Appeal, Judgment And Sentencing
Nature offCase)(Subject matter Controlled Substances Was the trial by: 0 jury or IZJ non-jury? or type o case : Date notice of appeal filed in trial court: May 13, 2015 Type of Judgment: Bench Trial If mailed to the trial court clerk, also give the date mailed : Date trial court imposed or suspended sentence in open court or date trial court entered appealable order: Offense charged: '.Poss CS PG 1 >=400g w/ intent to deliver Punishment assessed: 15 Years
Date of offense: September 23, 2011 Is the appeal from a pre-trial order? D Yes [gi No Defendant's plea: Not Guilty Does the appeal involve the constitutionality or the validity of a statute, rule or ordinance? If guilty, does defendant have the trial court's certificate to appeal? 0Yes jg!No [g]Yes D No
VI. Actions Extending Time To Perfect Appeal
Motion for New Trial: ~Yes D No Ifyes, date filed : May 20, 2015 Motion in Arrest of Judgment: [8l Yes 0 No If yes, date filed: May 20, 2015
Other: D Yes IZJ No If yes, date filed:
If other, please specify:
VII. lndigency Of Party: (Attach file-stamped copy of motion and affidavit)
Motion and affidavit filed: [gl Yes D No D NA If yes, date filed: November 13, 2013 Date of hearing: IZJ NA Date of order: November 13, 2013 DNA Ruling on motion: ~ Granted D Denied D NA If granted or denied, date of ruling: November 13, 2013
Page 2 of 5 VIIl. Trw Court And Record
Court: 7lst District Court Clerk's Record:
County: Harrison County Trial Court Clerk: t8:j District D County Trial Court Docket Number (Cause no): 12-0427X Was clerk's record requested? ~Yes 0 No Trial Court Judge (who tried or disposed of the case): If yes, date requested: May 13, 2015 If no, date it will be requested: First Name: Brad Were payment arrangements made with clerk? Middle Name: D Yes D No ~Indigent
Last Name: Morin Suffix: Address I : 200 W. Houston Street, Suite 219 Address 2: City: Marshall State: Texas Zip + 4: 75670-4027 Telephone: 903-935-8407 ext. Fax: 903-935-9963 Email: lesliem@co.harrison.tx.us
Reporter's or Recorder's Record: Is there a reporter's record? ~ Yes D No Was reporter's record requested? IZjYes 0No Was the reporter's record electronically recorded? ~Yes D No If yes, date requested: May 13, 2015 Were payment arrangements made with the court reporter/court recorder? 0Yes 0No ~Indigent
~ Court Reporter 0 Court Recorder IX! Official D Substitute
First Name: Tanya Middle Name: Last Name: McFarland Suffix: Address 1: 200 W. Houston Street, Suite 219 Address 2: City: Marshall State: Texas Zip + 4: 75670-4027 Telephone: 903-935-8407 ext. Fax: 903-935-9963 Email: tanyam@co.harrison.tx.us
Page 3 of5 IX. Related Matters
List any pending or past related appeals before this or any other Texas appellate court by court, docket number, and style. Docket Number: Court:
Style:
X. Signature
Signature of counsel (or Pro Se Party) Date: July 24, 2015
ob-Qx---t L . Cole~ State Bar No: 04547800 Printed Name:
Electronic Signature: Isl Robert Lee Cole, Jr. Name: Robert Lee Cole, Jr. (Optional)
XI. Certificate of Service
The undersigned counsel certifies that this docketing statement has been served on the following lead counsel for all parties to the trial court's order or judgment as follows on July 24, 2015
Electronic Signature: Isl Robert Lee Cole, Jr. (Optional)
State Bar No.: 04547800
Certificate of Service Requirements (TRAP 9.5(e)): A certificate of service must be signed by the person who made the service and must state: ( 1) the date and manner of service; (2) the name and address of each person served, and (3) if the person served is a party's attorney, the name of the party represented by that attorney
Page 4 of 5 Please enter the following for each person served:
Date Served: July 24, 2015 Manner Served: eServe First Name: Coke Middle Name: Ward Last Name: Solomon Suffix: Law Firm Name: Harrison County District Attorney Address 1: 200 W. Houston Street, 2d Floor Address 2: City: Marshall State Texas Zip+4: 75670-4027
Telephone: 903-935-8408 ext. Fax: 903-938-9312 Email: cokec@co.harrison.tx.us
Page 5 of 5 CAUSE NO. \d-04;AJ x OFFENSE 1'LS fb l :;L l\Q)~ res 3fa~ ;:;:- ~L~ The.State..oilexau'S..~ 1(z.( Om.f.. Anlatln - 71 st Judicial District Cou~ ---mITisoneauntr,re., : ) ;:;.; -!i SI r("') ::o '-H l> _._
rn ::o ~ ::::0
In the Interest of a . o~r Juvenile~....,;.. E§ ~~l> - < ( .) ~z 0 C") '"Tl -I Q 0 ;;o c ;u - :z ;o -< ..,,,. (") :I rs>~ .,.. ("') --j -I ("');< (") fT1 0 ~ O-i ::0 ::i C> ;;.;,;. c:: ni 0 YOUR ATIORNEY' S NAME ADDRESS - ~ PHONB:a ~i .. ATIORNEY (.~
Abraham, Bruce 306C W. Houston St. (903) 934-8844 Marshall, TX 75670 (903) 487-4277 (F) Berry, Rick 111 W. Austin St. (903) 938-6044 Marshall, TX 75670 (903) 938-1118 (F) Betzler, Katherine 400 Repose Lane, Ste. A (210) 842-9749 Marshall, TX 75670 Black, Joe 201 West Houston (903) 472-4600 Marshall, TX 75670 (903) 215-8514 (F) Carpenter, Laura 106 West Houston (903) 938-7440 Marshall, TX 75670 (903) 938-3008 (F) Castleberry, Rick P.O. Box 2127 (903) 935-5427 Marshall, TX 75672 (903) 934-9017 (F) Choy, Lana 2660 E. End Blvd S., Ste 110 (903) 212-2469 Marshall, TX 75670 (903) 238-9040 (F)
/ Cole, Robert Jr. P.O. Box 1511 Marshall, TX 75671 (903) 503-7918 (903) 938-0235 (F) Cooper-Sammons, Cheryl 110 S. Bolivar St. Ste. 214 (903) 472-4101 Marshall, TX 75670 (903) 935-1372 (F) Dansby, Kyle P.O. Box 1914 (903) 738-6162 Marshall, TX 75671 (888) 410-1583 (F) Hagan, Rick P. 0. Box 3347 (903) 757-9877 Longview, TX 75606 (903) 218-4089 (F) Harris, Matthew 222 N. Fredonia (903) 757-7500 Longview, TX 75606 (903) 215-8467 (F) Hurlburt, Richard 222 N.
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ACCEPTED 06-15-00112-CR SIXTH COURT OF APPEALS TEXARKANA, TEXAS 7/24/2015 3:27:43 PM Appellate Docket Number. 06-15-00112-CR DEBBIE AUTREY CLERK Appellate Case Style: Style: '.Jerome Lydale Anderson
Vs. State of Texas
FILED IN Companion Case: I I 6th COURT OF APPEALS TEXARKANA, TEXAS 7/24/2015 3:27:43 PM DEBBIE AUTREY Clerk Amended/corrected statement: D DOCKETING STATEMENT (Criminal) Appellate Court: 6th Court of Appeals (to be filed in the court of appeals upon perfection of appeal under TRAP 32)
L Appellant Il. Appellant Attomey(s)
First Name: Jerome I ~ Lead Attorney
Middle Name: Ly dale I First Name: Robert i Last Name: Anderson I Middle Name: Lee I I Suffix: Last Name: Cole I Appellant Incarcerated? [gJ Yes D No Suffix: Jr. Amount of Bond: ~Appointed D District/County Attorney 0Retained D Public Defender Pro Se: 0 Firm Name: Law Office of Robert Cole I Address 1: 409 N. Fredonia, Suite 101 I Address 2: J City: Longview j State: Texas Zip+4: 75601 Telephone: 903-236-6288 ext t l Fax: 903-236-5441 I
Email: rcolejd@gmail.com .I SBN: 04547800 i IAdd Another Appellan4 Attorney
Page I of5 ID. Appellee IV. Appellee Attomey(s)
First Name: State of Texas [gl Lead Attorney Middle Name: First Name: Coke
Last Name: Middle Name: Ward Suffix: Last Name: Solomon Appellee Incarcerated? D Yes ~ No Suffix:
Amount of Bond: D Appointed ~ District/County Attorney Pro Se: 0 0Retained D Public Defender Firm Name: Harrison County District Attorney Office Address I : 200 W. Houston Street, 2d Floor Address 2: City: Marshall State: Texas Zip+4: 7567o-4027 Telephone: 903-935-8408 ext. Fax: 903-938-9312 Email: cokec@co.harrison.tx.us Add Another Appeilee/ SBN: 24041954 Attorney
V. Perfection Of Appeal, Judgment And Sentencing
Nature offCase)(Subject matter Controlled Substances Was the trial by: 0 jury or IZJ non-jury? or type o case : Date notice of appeal filed in trial court: May 13, 2015 Type of Judgment: Bench Trial If mailed to the trial court clerk, also give the date mailed : Date trial court imposed or suspended sentence in open court or date trial court entered appealable order: Offense charged: '.Poss CS PG 1 >=400g w/ intent to deliver Punishment assessed: 15 Years
Date of offense: September 23, 2011 Is the appeal from a pre-trial order? D Yes [gi No Defendant's plea: Not Guilty Does the appeal involve the constitutionality or the validity of a statute, rule or ordinance? If guilty, does defendant have the trial court's certificate to appeal? 0Yes jg!No [g]Yes D No
VI. Actions Extending Time To Perfect Appeal
Motion for New Trial: ~Yes D No Ifyes, date filed : May 20, 2015 Motion in Arrest of Judgment: [8l Yes 0 No If yes, date filed: May 20, 2015
Other: D Yes IZJ No If yes, date filed:
If other, please specify:
VII. lndigency Of Party: (Attach file-stamped copy of motion and affidavit)
Motion and affidavit filed: [gl Yes D No D NA If yes, date filed: November 13, 2013 Date of hearing: IZJ NA Date of order: November 13, 2013 DNA Ruling on motion: ~ Granted D Denied D NA If granted or denied, date of ruling: November 13, 2013
Page 2 of 5 VIIl. Trw Court And Record
Court: 7lst District Court Clerk's Record:
County: Harrison County Trial Court Clerk: t8:j District D County Trial Court Docket Number (Cause no): 12-0427X Was clerk's record requested? ~Yes 0 No Trial Court Judge (who tried or disposed of the case): If yes, date requested: May 13, 2015 If no, date it will be requested: First Name: Brad Were payment arrangements made with clerk? Middle Name: D Yes D No ~Indigent
Last Name: Morin Suffix: Address I : 200 W. Houston Street, Suite 219 Address 2: City: Marshall State: Texas Zip + 4: 75670-4027 Telephone: 903-935-8407 ext. Fax: 903-935-9963 Email: lesliem@co.harrison.tx.us
Reporter's or Recorder's Record: Is there a reporter's record? ~ Yes D No Was reporter's record requested? IZjYes 0No Was the reporter's record electronically recorded? ~Yes D No If yes, date requested: May 13, 2015 Were payment arrangements made with the court reporter/court recorder? 0Yes 0No ~Indigent
~ Court Reporter 0 Court Recorder IX! Official D Substitute
First Name: Tanya Middle Name: Last Name: McFarland Suffix: Address 1: 200 W. Houston Street, Suite 219 Address 2: City: Marshall State: Texas Zip + 4: 75670-4027 Telephone: 903-935-8407 ext. Fax: 903-935-9963 Email: tanyam@co.harrison.tx.us
Page 3 of5 IX. Related Matters
List any pending or past related appeals before this or any other Texas appellate court by court, docket number, and style. Docket Number: Court:
Style:
X. Signature
Signature of counsel (or Pro Se Party) Date: July 24, 2015
ob-Qx---t L . Cole~ State Bar No: 04547800 Printed Name:
Electronic Signature: Isl Robert Lee Cole, Jr. Name: Robert Lee Cole, Jr. (Optional)
XI. Certificate of Service
The undersigned counsel certifies that this docketing statement has been served on the following lead counsel for all parties to the trial court's order or judgment as follows on July 24, 2015
Electronic Signature: Isl Robert Lee Cole, Jr. (Optional)
State Bar No.: 04547800
Certificate of Service Requirements (TRAP 9.5(e)): A certificate of service must be signed by the person who made the service and must state: ( 1) the date and manner of service; (2) the name and address of each person served, and (3) if the person served is a party's attorney, the name of the party represented by that attorney
Page 4 of 5 Please enter the following for each person served:
Date Served: July 24, 2015 Manner Served: eServe First Name: Coke Middle Name: Ward Last Name: Solomon Suffix: Law Firm Name: Harrison County District Attorney Address 1: 200 W. Houston Street, 2d Floor Address 2: City: Marshall State Texas Zip+4: 75670-4027
Telephone: 903-935-8408 ext. Fax: 903-938-9312 Email: cokec@co.harrison.tx.us
Page 5 of 5 CAUSE NO. \d-04;AJ x OFFENSE 1'LS fb l :;L l\Q)~ res 3fa~ ;:;:- ~L~ The.State..oilexau'S..~ 1(z.( Om.f.. Anlatln - 71 st Judicial District Cou~ ---mITisoneauntr,re., : ) ;:;.; -!i SI r("') ::o '-H l> _._
rn ::o ~ ::::0
In the Interest of a . o~r Juvenile~....,;.. E§ ~~l> - < ( .) ~z 0 C") '"Tl -I Q 0 ;;o c ;u - :z ;o -< ..,,,. (") :I rs>~ .,.. ("') --j -I ("');< (") fT1 0 ~ O-i ::0 ::i C> ;;.;,;. c:: ni 0 YOUR ATIORNEY' S NAME ADDRESS - ~ PHONB:a ~i .. ATIORNEY (.~
Abraham, Bruce 306C W. Houston St. (903) 934-8844 Marshall, TX 75670 (903) 487-4277 (F) Berry, Rick 111 W. Austin St. (903) 938-6044 Marshall, TX 75670 (903) 938-1118 (F) Betzler, Katherine 400 Repose Lane, Ste. A (210) 842-9749 Marshall, TX 75670 Black, Joe 201 West Houston (903) 472-4600 Marshall, TX 75670 (903) 215-8514 (F) Carpenter, Laura 106 West Houston (903) 938-7440 Marshall, TX 75670 (903) 938-3008 (F) Castleberry, Rick P.O. Box 2127 (903) 935-5427 Marshall, TX 75672 (903) 934-9017 (F) Choy, Lana 2660 E. End Blvd S., Ste 110 (903) 212-2469 Marshall, TX 75670 (903) 238-9040 (F)
/ Cole, Robert Jr. P.O. Box 1511 Marshall, TX 75671 (903) 503-7918 (903) 938-0235 (F) Cooper-Sammons, Cheryl 110 S. Bolivar St. Ste. 214 (903) 472-4101 Marshall, TX 75670 (903) 935-1372 (F) Dansby, Kyle P.O. Box 1914 (903) 738-6162 Marshall, TX 75671 (888) 410-1583 (F) Hagan, Rick P. 0. Box 3347 (903) 757-9877 Longview, TX 75606 (903) 218-4089 (F) Harris, Matthew 222 N. Fredonia (903) 757-7500 Longview, TX 75606 (903) 215-8467 (F) Hurlburt, Richard 222 N. Fredonia (903) 234-8181 Longview, TX 7560 I (903) 757-2387 (F) Hyatt, Jon 2660 E End Blvd S., Suite 111 (903) 234-9544 Marshall, TX 75672 (903) 234-1 688 (F) Miller, Kimberley 110 S. Bolivar St. Ste I 07 (903) 472-4934 Marshall, TX 75670 (888) 753-8808 (F) Reaves, Allen 222 Renaissance Dr. (903) 331-0353 Hallsville, Texas 75650 (903) 331 -0355 (F) Rectenwald, Scott 110 W. Fannin (903) 938-3300 Marshall, TX 75670 (903) 938-3310 (F) Smith, Stephen 50 I Spur 63, Suite C-6 (903) 753-7636 Longview, TX 75601 (903) 753-1926 (F) Solomon, Vemard I 03 E. Houston (903) 938-4555 Marshall, TX 75670 (903) 938-5151 (F)
The above named attorney has been appointed to represent you. They will contact you within 24 hours by phone and/or in person and within 72 hours with a personal visit.
B~DING FIDA VIT OF INDIGENCE Tliis section to be filled out by Court Personnel
No. n» The State of Texas In the 7 / ~ Q/T'E--Court CD -< rA'_,, rri ::o _ :;o-, :;,;; g;fTl - v . ' ~ ~:z:O - --~~ ~~ -~-
J fd]-MQ_ /.t-AJu;;rorV % o » -iOO ::oc;o - :;z: ;;o (") -i(T'\ Offense _____ '(_ . () ~._C_._S_-_ :IC -< ("") -i Level of Offense - - -- - - n·o it o-4;n ._----------------------------------------------------------------~"----'I/I" r. ~ §E~O ~'·~--JJIS-,,,,..t:.:=--.....,::.:1.;.a:-.t:>-~<..~.>.~\l.~....... n.~_.......~.,.= ·-·r.-<.r
1An information must be completed by the defendant and must be current, accurate, and true/ Intentionally! U> for knowingly giving false information may result in your prosecution for the offense of aggravated perjury,! 1a felony. The punishment for aggravated perjury includes imprisonment not to exceed ten (10) years and a ~ l tine not to exceed ten thousand dollars ($10,000). Please fill in all blanks. If you do not know the i lj' information being asked, enter DO NOT KNOW in the blank. If the information being asked does not! apply to you, enter N/A in the blank. ....,.......,,___.__ _ _ _______~-,--~"'-"":~• ·~···~-.,~~••><·-·-·~-,-~··-,-~•-==~-~,~·--m,.,J 1
... - - Defendant's Personal Information :_~Nam~~~--~~- ~- ---· . - -yif6'N1 e.· · z9 ~;;[-;;1. ~..... ?t;-J~i:;~------------· :--~o~~--N~~~~_!: __ :JIJ'- _~5'3- ii 3 6 ~f'}" "'. __ _____________ _ .~treetA~~_r_~s_s . _ ... :J.op. 0 qdJy Br()-,,.Jll ~a. 1 ·- ~·~_!_~!~~eLZ_ip_____ _. _ f{J~Yld_e.fl _1.,,-R- __ 7_;_~£_>:'. ~-Soci~! Sec_ll:!°i~ -~---- • 1/3? - j f:" ..,. t> 7 i «( _Dti_".~-'~_1=!cense ~- __ -----·- {21?.~~!~fS"F) :_!?~!~.2U3Jt!h_-·-- . . . ~ - ? ? ~ 78.' -~_a.f!le of Spouse
. _Qe.p_e.Q_d~-~~.s~ __ .... Name(s) ·------ (list below): Age -- Income -- ------ ·- ------. _ _ fl:;..:; ..... err.{{)... ------- - "lfn_d r1 - /3 / (b -- ~..... pn.fl., I . -1 - .. _JI ._ffl ftn d e- r J o n - ~ 1tzJ /"" .,,._ Ii l 7-
.- . _A~~ c:;~rref]tly i.n j~il or ~11 a co_r.recti
~=- )[~_- I f ~es, PIQVid~-~-~-~ .2.f.i!!s._t}_~tL~-~ ----- -_:_ ... ----·-··-·······--· - -· ......... ····· ---···- ... ·- . AE.~X
VNo-- - - __ _ Y~ .. }_f)'_~s._, P~2VJ~e 11.!lm~_o_f_f~~ilL~: __
Yes If yes, provide name of facility ~~ii~~;~i~0_:=-~io~__ :- ~ ffi_~(ef __ - c~i-z -i-r~ --~----~--~===-~-~- ~==~ 1 _ ~ho_!l~_l:'!_~~-~~r _. : 11e- ~ ~r? - tJ, 1- ~ . -~~~:7:~~~~~~~-. -~- i? ~lf::r1~ ,f;-e>WA !Yi. . -- ....... ---------·-·-. . - ci1Y~si~t-~; Zip · m~~n£<£5.___~----------------·-----------~ ' Hours worked _per week or _ per month Pay rate . --·-- ·----------- ------------···------·-·- _______________________________ --·-·--·-----------·--------------··--, Sp
Public Assistance . Income (Monthly) --- ------,-Monthly·--- _A.I_~)'.2._l!_ CE~~_!l~ly _r~ce!vi_11g _( ch~~k_a_l_l !~a_t apply) 1 ... ··- ___ j A_~otgit . Food Stamps · _Take Home Pay .. __ Medicaid : Spouse's Take Home_P_ay Public housing Temporary Assistance to Needy Families (TANF) :_ I11~~~1_!_1~nt !g~_om~ ---- -·· __ ·--------·--- · ___ Stock Dividend _ __ ~upplemental Security IncolT!e (SSI) Bond Dividend - --- ·-. - :·Expenses (Monthly) .... Monthly · Rental Income ·)l~" 0 ' _________ ________ ____ _!_~ym~!1..! Pension Payments ~~9.i:tgage Payment ~ '6 0 · Unemployment .. _-~P-~l)'.!!J~nt_ .. __ . --·· . . _ . S()~ial_ Sec~~ity -Ben~fl!s :.- ! Insurance (Life, Health, Car, Child _S~PP?!!_ . _J''f ~ D_ .. _.f:I~n~eowners, etc.) Public Assistance _f_hilc!._~a.r~.. - --- - .. - .. ... . ··- .. --·· -- -· -- . - -· TANF ···--------- -- --····- -··-------------------- SSI
------ -· -.. . -·· · -·--- ·- ----~~ii ru-- , Medicaid ;-·-. 0th~~- . -- """ __-·-.-'-~,...,~~ ~i~ \ t.~O · Cash Gifts ~-oth-;;~eo-~c~ib~r ----------------· Fo~ ---·- __ ·---------- __ ---·-·--·----- __j~O Clothes Medical TOTAL GROSS Cable TV or Satellite TV _/() 0 MONTHLY INCOME ~age~ - 70 Cell Phone
:·C.re~t. ¢._~_~cl o~6i- (fist n1i"rr\e -~r carcis)-- - - Balance: $_ _ _ _ Balance: $____ ··-····-···· ····-·--·-···· ··--······· --··--·. -0~~!" !Y:!onth_ly Expenditu~es (Describe)
·-·--· --· --·-· ···- . . . .. -· - ··- ·-·· - -- TOT ALM ONTHL Y EXPENSES . Assets () ca Asset Value A. Place of Residence 1Rent - Own $ Describe if house, condominium, apartment, other: (ooo - B. Real Property Owned; Description/Location: $
_C. Automobile{sl Make Model - ~--- Year - -- - -~~~- ~ s-~ - --~·~--- --~--~-=- ~
Make Model Year $ Make Model Year $ D. Stock and Bonds (provide description) $
$
$ E. Other Property (list all jewelry, equipment, watercrafts, etc.) $ $ $ F. Bank Accounts Bank Name Type of Account Balance $ $ $ $
G. Other Assets (Identify) VALUE $
ASSETS TOTAL VALUE $
~ I have not (circle one) attempted to hire an attorney. The names of the attorneys I have contacted are as follows : Kyle t>~ 'y
On this Q day of /l.J0 t/ , 20 /..1_, I have been advised by the (name of the court) Court of my right to representation by counsel u;the trial of the charge pending against me. I am without means to employ counsel of my own choosing and I hereby request the court to appoint counsel for me. By signing my name below, I swear, that all of the above information about my financial condition is current, accurate, and true . By signing below, I understand that a court official can verify any of the information for accuracy as required to determine my eligibility.
~sifu&L---- Thi' '°"rt fin