Application to Serve as Assigned Counsel

Application Status (Deadline is March 31, 2019)

Initial Application
Renewal
Redesignation
Reinstatement

Contact Information

Name *

Business Address *

E-Mail Address *

Phone *

Fax

Registration

Admitted to Ohio Bar *

Registration Number *

What are the years for your biennial registration? *

Cases

I have served as trial counsel in the following cases which were tried to verdict. Include Docket Number, Defendant Name, Highest Charge, Date of Trial, Court or Jury Trial, Judge for each case, Lead or Assistant. Complete for intital application / redesignation or reinstatement, if applicable (Not required for renewal)

Case 1

Case 2

Case 3

Case 4

Case 5

Confirmation

I certify the following. By doing so, I acknowledge that all of the information I am providing is correct and truthful: *

Attachment: Proof of Insurance

Attachment: Most recent CLE transcript for criminal practice and procedure (WAIVED FOR 2019)

I have other relevant qualifications for consideration. (please attach here)