Applying for a Public Defender (Domestics Division)

Applying for a Public Defender (Domestics Division)

Delaware County, Pennsylvania
Every question must be answered or your application will not be accepted.
The Public Defender’s Office may request proof of any/all answers.
Case & Client Information

Provide information regarding your case and yourself.
Hearing Type*

PFA ViolationChild Support Contempt
Hearing Date*

MonthDayYear
If your hearing date is on a Monday or Wednesday, we CANNOT represent you.
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
Employment & Assets

Detail your employment, income and asset information.
Are you currently employed?*

YesNo
Employed By*
Hours per Week*
When was the last time you worked?*
For whom?*
Weekly Income*
Do you receive any form of benefits? (Unemployment, Food Stamps, etc.)*

YesNo
Do you receive unemployment?*

YesNo
If yes, how much?*
Unemployment amount received
Do you receive social security?*

YesNo
If yes, how much?*
Social Security amount received
Do you receive cash assistance?*

YesNo
If yes, how much?*
Cash Assistance amount received
Do you receive food stamps?*

YesNo
If yes, how much?*
Food Stamps amount received
Do you receive medical assistance?*

YesNo
If yes, how much?*
Medical Assistance amount received
Do you own or rent?*

OwnRent
Monthly Mortgage*
Monthly Rent*
Do you own a car?*

YesNo
Vehicle Year*
Vehicle Make*
Other Assets*
If no other known assests, type "None" or "N/A"
Monthly Bills

How much do you spend on the following:
If you're not working, how do you pay bills?*
Monthly Phone Bill*
Monthly Gas/Electric Bill
Monthly Water Bill
Monthly Food Costs*
Other Monthly Bills*
For PFA Contempt Cases Only

Please complete the following specific questions.
PFA Order Issue Date*

MonthDayYear
Date
For How Long?*
Relationship to person who filed PFA*
Do you have criminal charges for this contempt?*

YesNo
If yes, when is your preliminary hearing date?*

MonthDayYear
Date
Judge*
Additional Comments
Provide any additional details, comments or notes regarding your case.
For Child Support Contempt Cases Only

Please complete the following specific questions.
Support Order Amount *
For how many children?*
Ages of Children*
PACSES Number*
Date of Last Payment*

MonthDayYear
Date
Amount Paid*
Additional Comments
Provide any additional details, comments or notes regarding your case.
Affidavit

Read the affidavit carefully and sign below.
I understand the Public Defender provides free legal assistance to people who cannot afford an attorney with criminal charges against them in Delaware County.*

YesNo
I affirm that I cannot afford to hire an attorney to represent me in my criminal case.*

YesNo
Confirmation Signature*

Clear
Please verify that you are human*
Should be Empty:

Applying for a Public Defender (Domestics Division)

Case & Client Information

Employment & Assets

Monthly Bills

For PFA Contempt Cases Only

For Child Support Contempt Cases Only

Affidavit