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Public Defender Application

  1. Personal Information
  2. Are you a US Citizen?
  3. Accept Text?*
  4. Accept Email?
  5. Gender
  6. Are you a Veteran?
  7. Do you currently receive Public Assistance?*
  8. Do you currently receive SSI/SSD?*
  9. Have you been found eligible for assigned counsel in another criminal case within the past 6 months?*
  10. Please write "n/a" if you are only household member
  11. Court Information
    You must submit your charging documents or Family Court petition in order to be eligible for a Public Defender.
  12. If being charged criminally, please give a brief description of charges. N/A if Family Court.
  13. If you have a copy of your court documents, please upload them here.
  14. Employment/Expenses Information
    If you are working, you must submit your most recent paycheck stub(s) in order to be considered for Public Defender representation.
  16. Are you currently working?*
  17. Please write "n/a" if not working
  18. Approximate if necessary, "n/a" if not working
  19. Rent/Mortgage, Utilities, etc.
  20. Do you pay child support?
  21. If you have a copy of your recent paycheck stubs, retirement income, etc., please upload them here.
  22. Please submit this form and supply any court documents and proof of income as soon as possible in order for your application to be processed. Our contact information is as follows:
  23. Livingston County Public Defender 6 Court Street, Room 109 Geneseo, NY 14454 Phone: (585) 243-7028 Fax: (585) 243-7193 Email:
  24. Leave This Blank:

  25. This field is not part of the form submission.