Waiver Of Right To Have Appointed Counsel

____________ Court ______________County WAIVER OF RIGHT TO HAVE Case Number APPOINTED COUNSEL ________________Tennessee Page 1 of 1 _____________________________________ vs. ______________________________ ___ The undersigned represents to the court that he/she has been informed of the charges against him/her, the nature thereof, the statutory punishment therefore and the right to appointment of counsel upon his representation to the court that he is unable to employ counsel and the reasons therefore, all of which he/she fully unders tands. The undersigned now states to the court that he/she does not desire the appointment of counsel, expressly waives the same and desires to appear in all respects in his/her own behalf, which he understands he/she has the right to do. Date: _________________________ __________________________________________ Defendant Signatur e __________________________________________ Clerk / Deputy Clerk - Circuit Cour t