APPLICATION FOR APPOINTMENT

OF COUNSEL AND PAYMENT FROM LEGAL AID FUND

ADMINISTERED BY THE HIGH COURT

APPLICATION NON IJJITON LAWYER IM KOLLAIK JEN LEGAL AID FUND EO HIGH COURT EO EJ BOK EDDOIN

I, ______, hereby apply for the appointment of Counsel to represent me. I declare I am without adequate funds to pay for counsel in full or in part. I declare that: (Check one of the following):

Na, ______, ijkanne application in non an Court jiton juon ao lawyerilo ejelok woneen non na. Ijkwalok ke ejabwejaanippa non aomaron inkollaik, ilolikioakjidrikin, wonen juon ao lawyer. Ijkwalok ke: (Kokaleik juon ian box kein ilal):

I intend to file a lawsuit against the following persons, group or corporation.

Ij konan komman ao case ak abnono nae armej, droulul, corporation, in/rein ilal.

List all: ______

Kolajraketaeraolep:

______

______

I am being sued by the following (Emoj an in/rein ilal komman an/aer abnono nae io im liakelokio ilo Court):

List all(Kolajraketaeraolep): ______

______

______

In High Court Action Number ______

Ilo High Court Case Numba:

I intent to intervene:

Ij konan drelon im mottanuwaan ro rej case i dron ilo case in ilal:

In High Court Action Number (Ilo High Court Case Numba) ______

The following is true and correct(Melele kein ilal rejimwe im mol):

  1. My full name (Likio in eta) ______
  2. Date of Birth (Iienlotak eo ao) ______
  3. Occupation(Kain jerbal eo ao) ______
  4. Currently employed(Ij jerbal ilo tore in)Yes (Aet) No(Jaab)

A: If yes(Elaneaet),

(1)where do you work(kwoj jerbal ia)?

Name(Etan jikin jerbal eo): ______

Address(Box numbaak jikin eo ej bed ie): ______

(2)When did you start work there?(Kwarjino jerbal naat?) ______

( Month-Allon / Year-Iio )

B: Income received monthly from employment $______

Jonan jaaneokwojloeakwoneem ilo juon allonilo jerbal eo am

If no, (1) When did you last work? (Month/Year) ______

Elanejaab, (1) Naateoeliktatakwar jerbal? (Allon / Iio)

(3)What was your total salary per month $______

Karjetewoneemilo juon allon

  1. Total number of minor children you support ______

Jeteoranajiriilalin 18aeriiokwojlaleir im kake aikuj ko aer

6. Are you married and living with your wife/husband? Yes-Aet / No-Jaab

Kwoj ke juon ri-marre im kwojjokwe ke ippen lio/akleobelele?

7. Is your wife / husband employed?Yes -Aet / No-Jaab

Kora eoakleoippam ej ke jerbal?

(a)If yes, where is he/she employed? ______

Elaneaet, ej jerbal ia?

(b)Total monthly salary received $ ______

Jetewoneenilo juon allon

8. List all other total income available to you and source $______

Ebarwor ke jaankwojloeak rej kollaikwaj non kwe? Jete im kalajrak jen ia.

9. Are you receiving any other money from(Kwojbok ke am kolla jen):

  • Nuclear Claims?Yes-Aet / No-Jaab
  • Rental?Yes-Aet / No-Jaab
  • Other? Ijoko jet?Yes-Aet / No-Jaab $______

List all persons living with you and those you support.

(Kalajraketanaolep ro rej jokweippam im ro kwoj support ak kake aer aikuj).

______

______

______

Monthly Expenses – for yourself and others. Woneenakjonan eo kwojjolokakkollaik aoleb allon ikijen men kein rej lajrak ilal – non kweak ro jet.

  1. Mortgage(WoneenMon jokwe eo) -
  2. Car Payment(Woneenwa eo waam) -
  3. Bank loans(Loon ko ilo bank) -
  4. Education [ yours & children](Woneenjikuul [kweakajirieo/ro]) -
  5. Food(Mona) -
  6. Clothing(Nuknuk) -
  7. Phone(Talboon) -
  8. Electricity(Jarom) -
  9. TV/Cable -
  10. Others(Ko jet) -

I understand that I, and my successors and assigns, will be responsible for payment for attorney fees and costs if I recover money from my lawsuit. I declare under penalty of perjury the foregoing is true and correct.

Imeleleke na,ak ro renej bok jiku im ro inejjitonir, kem naj bok eddoinkollaikwoneen lawyer eo, ekobawoneen ko jet, elane enaj worjaaneninajbokeakkollaik tok non na jen wot case in ao. Ij kamol im kalimur, iloao melele ke enaj worruoelaneinejriab,ke aolep melele kein ilo application in rej walok ijinilonrejimwe im remol.

Date(Raan eo): ______

Signature (Sign eo am)

CONTACT INFO:Address:______

MELELE KO NON TOBAR IO:(Box numbaakbukon im jikin jokwe)

Email:______

Telephone/Cell phone:______

Required attachments:

Pepako jet im rej aikuj itok ippen application in am:

  1. Letter from Micronesian Legal Services Corporation (MLSC) stating reason why they cannot take your case.

Juon letter akkomlele ilo jeje jen Micronesian Legal Service Coproration (MLSC) uninaerjab maron jiban yuk kin abnono akcase in am.

  1. A brief explanation/summary of your case(to be provided to the attorney if application approved).

Juon komleleilojeje jen kwe eo im ej letok melele ko ilo tu-kadu kin abnono ak case in am. Pepa in enaj etal non lawyereonaj jitoneelane enaj tobrak applicationakkajitok in am.

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