Fill and Sign the Appearance Form Criminal Ingov

Form TCM -CR2.1 -5 Authorized by Office of Court Services 10 /17 APPEARANCE FORM (CRIMINAL – DEFENDANT SELF REPRESENTED ) IN THE _ _____________________ ____________________ COURT THE STATE OF INDIANA ) ) vs. ) Case Number: __________________________ ) ____________________________ ) (Insert Name of Defendant ), ) DEFENDANT . ) Appearance by Self Represented Defendant 1. The undersigned Defendant now appear s in this case and elects to represent himself/herself without the assistance of legal counsel . 2. Defendant information (as applicable for service): Name (printed) : _________________ _________________ ______________ Address: ________________________________________________ ________________________________________________ ________________________________________________ Telep hone: ______________ __________________________________ Email Address: ________________________________________________ 3. Additional information specified by state or local rule required to maintain the information management system employed by the court : _________________ _______________________________________________________ ________________________________________________________________________ ________________________________________________________________________ CERTIFICATE OF SERVICE The undersigned certifies that a copy of the foregoing document has been served upon the following parties by the indicated methods: __________________________________________ ______________________________________________________________________________ _________________________________ _____________________________________________ ______________________________________________________________________________ (List Individual Parties & Method of Service) on _________________________. Form TCM -CR2.1 -5 Authorized by Office of Court Services 10 /17 Date: _________________ ________ ___________________ ______________ (Defendant’s Signature) _________________________________________ (Printed Name) Authority: Under Criminal Rule 2.1( D), this form shall be filed at the time a defendant elects to represent self without the assistance of l egal counsel . In emergencies, the requested information shall be supplied when it becomes available. Parties shall advise the court of a change in information previously provided to the court. This format is approved by the Indiana Office of Court Services .