IN THE SUPERIOR COURT FOR THE STATE OF ALASKA

In the Matter of:	)

)

A minor under 18 years of age.	)	CASE NO.

)

Date of Birth:	)	ORDER APPOINTING/DENYING

COUNSEL - DELINQUENCY

The court was asked to appoint an attorney to represent the

minor named above

minor’s parent/guardian named

The contact information of the person asking for an attorney is:
[ check here and leave the lines below blank if confidential]

Address:

Email:	Phone:

IT IS ORDERED that:

The request is denied. A private attorney may be consulted. If you are using an attorney, notify the court within 10 days.

The request is granted. Upon adjudication of delinquency, the parent or guardian will be ordered to pay part of the cost of appointed counsel pursuant to Delinquency Rule 16 and Criminal Rule 39.

The Public Defender Agency is appointed.

The Office of Public Advocacy is appointed.

Contact the appointed attorney within days at:

Address:

Phone:

Next Hearing:

Purpose:

Effective Date	Judicial Officer

Type or Print Name

I certify that on	a copy of this order was distributed to:

The person for whom an attorney was appointed Appointed Attorney

Parent/Guardian DJJ DA Detention or Placement Facility GAL

Clerk: