TENNESSEE STATE LODGE
FRATERNAL ORDER OF POLICE
LEGAL AID APPLICATION

NAME________________________________________DATE____________________________________
ADDRESS______________________________________________________________________________
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WORK PHONE (____)_______________HOME PHONE (___)_____________________

LOCAL LODGE NAME & NUMBER__________________________________________

____ I HAVE RETAINED AN ATTORNEY OF MY CHOICE UNDER EMERGENCY CIRCUMSTANCES.

ATTORNEY'S NAME_______________________________________________________
ADDRESS (INCLUDE PHONE NUMBER)  _____________________________________
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APPROVED BY:______________________________ DATE_______________________

____ I HAVE NOT RETAINED AN ATTORNEY AND WISH FOR THE STATE LODGE TO APPOINT  AN  ATTORNEY TO REPRESENT ME.

TYPE OF INCIDENT (ADMINISTRATIVE, CIVIL, CRIMINAL) AS BRIEFLY AS POSSIBLE. DESCRIBE THE ALLEGATIONS OR CHARGES BEING MADE.  PLEASE INDICATE, IF KNOWN, WHAT COURTS WOULD HEAR YOUR CASE.  USE  A SEPARATE SHEET OF PAPER IF NECESSARY TO EXPLAIN THE DETAILS/ CIRCUMSTANCES OF YOUR REQUEST.

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I CERTIFY THAT THE STATEMENTS CONTAINED IN THIS APPLICATION ARE TRUE AND CORRECT.

SIGNATURE_____________________________________________________DATE____________________