Office of Public Defender

Intake Form

Last Name

First Name

Date of Birth

Address 1

Address 2

City

State

Zip Code

Phone Number

Emergency Contact

Charge(s) (if known)

Case Number(s) (if known)

Judge (if known)

Court Date (if known)

If you don't have an open case, what are you applying for?

Financial Information

Are you working?

If yes, name of employer?

Monthly Income

Do you receive any of the following? (please click all that apply)

SSI
SSD
Medicaid
Veterans' Benefits
Food Stamps

Office of Public Defender

May 24, 2023, 10:38 AM

Title : Office of Public Defender

Description : Office of Public Defender

Building Or Entity Name : Courthouse Square

Street address : 310 Lakeside Avenue, Suite 400

City : Cleveland

State : OH

Zip code : 44113

Map URL : https://www.google.com/maps/search/Courthouse+Square+310+Lakeside+Avenue,+Suite+400+Cleveland+OH+44113+216.443.7223/@41.5021842,-81.7011065,17z/data=!3m1!4b1?entry=ttu

Phone number : 216-443-7223

Phone extension :

Fax number :

Email address : pdgeneral@cuyahogacounty.gov

Online form URL :