Appendix B to Part 153 - Acknowledgment of Limited Legal Representation (Sample)
32:1.1.1.5.47.0.44.6.37 : Appendix B
Appendix B to Part 153 - Acknowledgment of Limited Legal
Representation (Sample)
1. I, ____________, have been named as a suspect or defendant in
a matter to which I have been advised is subject to the
jurisdiction of the Military Extraterritorial Jurisdiction Act of
2000 (section 3261, et seq., of title 18, United States
Code.); hereinafter referred to as “the Act”). I have also been
informed that certain initial proceedings under 18 U.S.C. 3265 may
be required under this Act, for which I am entitled to be
represented by legal counsel.
2. I acknowledge and understand that the appointment of military
counsel for the limited purpose of legal representation in
proceedings conducted pursuant to the Act is dependent upon my
being unable to retain civilian defense counsel representation for
such proceedings, due to my indigent status, and that qualified
military defense counsel has been made available.
3. Pursuant to the Act, ____________, a Federal Magistrate
Judge, has issued the attached Order and has directed that that
military counsel be made available:
____ For the limited purpose of representing me at an initial
proceeding to be conducted outside the United States pursuant to 18
U.S.C. 3265, ____ For the limited purpose of representing me in an
initial detention hearing to be conducted outside the United States
pursuant to 18 U.S.C. 3265(b),
4. ____________, military counsel, has been made available in
accordance with Department of Defense Instruction 5525.bb, and as
directed by the attached Order of a Federal Magistrate Judge.
5. I (do) (do not) wish to be represented by ____________,
military counsel ____ (initials).
6. I understand that the legal representation of ____________,
military counsel, is limited to:
a. Representation at the initial proceedings conducted outside
the United States pursuant to 18 U.S.C. 3265.
____ (Initials)
b. The initial detention hearing to be conducted outside the
United States pursuant to the Military Extraterritorial
Jurisdiction Act of 2000 (18 U.S.C. 3261, et seq.).
____ (Initials)
c. Other proceedings (Specify):
____________. ____ (Initials) Signature of Person To Be Represented
By Military Counsel Signature of Witness* Attachment: Federal
Magistrate Judge Order
(Note: The witness must be a person other than the defense
counsel to be made available for this limited legal
representation.)