have not been rcvoked, 1 ;,or misdemeanors )_
The district clerk of t_b'e county 111 which you were convicted will make this form
available to you, on request,. without charge
apply to`;youl.'_lf any pages;are missing-from the form\',` or if .. reh u'mb,ered*or fomitted,;yoi`lr entirc,applica,tion may be dismissed §`S lnfo__n--.compliant, .
You must make a separate application on a separate form for each judgment of
court on the same day, you must make a separate application for each one-.-
.Answer every item that applies to yoil on the form D_o not attach any additional
pages for any item.
Yoi'i_;'mu,st"i_nc_iude""<_ ,®,a\~A\ Co\ I\;
_El`feccive: 'Janilarv 1"`?~01'4" 1
;Rev. .o..i~/ii 4/1"14-
(5)
(6)`
CZ)
(8),
'(9_1
. (:10)
wére`yv_n representedby@-._counsel?l If':_y.es,111wvi`de"thevaftoi*ney"'"s,;ii;\me:
C/l elm€. \M " Clax>\w€ \\
`What~ was"'the_. d,a§"f€_..that 'the judgmentj Was. euf.el_'.¢d`"?
5~ 9~- 07
F.o~e"'what, offense;.were;youl convicted 1111¢1 .whar~'was' che-"'.s'e'men"cei'~ §
A'§'jvww§\)\)@