MONTANA JUDICIAL DISTRICT COURT, COUNTY

* CAUSE NO.

STATE OF MONTANA, *

* JUDGE

Plaintiff, *

* ORDER APPOINTING

vs. *

* COUNSEL

, *

*

Defendant. *

* * * * * * * * * * * * * * * *

Application having been make to this Court by the above named Defendant in the above entitled proceeding, and the Defendant having filed an affidavit which has established prima facie that he is indigent, and the nature of the charge against him being such that he is entitled to court-appointed counsel in this cause.

IT IS HEREBY ORDERED, that , an attorney duly licensed to practice law in the State of Montana, is hereby appointed as counsel for the above named indigent, and that his compensation for his own services and time be fixed at $ per hour, and that said counselsubmit to this Court a statement showing his necessary expenses, miles traveled, as well as, if he represented Defendant in Justice or Municipal Court proceeding, an itemized statement of his time devoted to the Defendant's cause therein, from time to time during the pendency of this action or at the termination of this proceeding and of counsel's services therein, for his own compensation and reimbursement of this necessarily incurred expenses, mileage to be paid at the rate fixed by law.

DATED this day of , 19 .

District Court Judge