Waiver Of Right To Have Appointed Counsel

STATE OF TENNESSEE SHELBY COUNTY CHANCERY COURT DOCKET NUMBER WAIVER OF RIGHT TO HAVE APPOINTED COUNSEL 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/her representation to the court that he/she is unable to employ counsel and the reasons therefore, all of which he/she fully understands. 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/she understands he/she has the right to do. Date: ____________________________ __________________________________________ Defendants' signature __________________________________________ Deputy Clerk & Master Form WO-07/04 American LegalNet, Inc. www.USCourtForms.com