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

Homicide List

Major Felony List (1st, 2nd, 3rd degree)

Felony List

Rule 20 - Lead

Rule 20 - Co-counsel

Mental Health Docket

Malpractice

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.

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