§ Forms Petition for Relief From a Conviction or Sentence By a Person in State Custody

Forms. Petition for Relief From a Conviction or Sentence By a Person in State Custody

Petition for Relief From a Conviction or Sentence
By a Person in State Custody

(Petition Under 28 U.S.C. § 2254 for a Writ of Habeas Corpus)

Instructions

1. To use this form, you must be a person who is currently serving a sentence under a judgment against you in a state court. You are asking for relief from the conviction or the sentence. This form is your petition for relief.

2. You may also use this form to challenge a state judgment that imposed a sentence to be served in the future, but you must fill in the name of the state where the judgment was entered. If you want to challenge a federal judgment that imposed a sentence to be served in the future, you should file a motion under 28 U.S.C. § 2255 in the federal court that entered the
judgment.

3. Make sure the form is typed or neatly written.

4. You must tell the truth and sign the form. If you make a false statement of a material fact, you may be prosecuted for
perjury.

5. Answer all the questions. You do not need to cite law. You may submit additional pages if necessary. If you do not fill
out the form properly, you will be asked to submit additional or correct information. If you want to submit a brief or arguments, you must submit them in a separate memorandum.

6. You must pay a fee of $5. If the fee is paid, your petition will be filed. If you cannot pay the fee, you may ask to proceed
in forma pauperis (as a poor person). To do that, you must fill out the last page of this form. Also, you must submit a
certificate signed by an officer at the institution where you are confined showing the amount of money that the institution
is holding for you. If your account exceeds $___, you must pay the filing fee.

7. In this petition, you may challenge the judgment entered by only one court. If you want to challenge a judgment entered by a different court (either in the same state or in different states), you must file a separate petition.

8. When you have completed the form, send the original and two copies to the Clerk of the United States District Court at
this address:

            Clerk, United States District Court for _____
            Address
            City, State Zip Code

9. CAUTION: You must include in this petition all the grounds for relief from the conviction or sentence that you challenge. And you must state the facts that support each ground. If you fail to set forth all the grounds in this petition, you may be barred from presenting additional grounds at a later date.

10. CAPITAL CASES: If you are under a sentence of death, you are entitled to the assistance of counsel and should
request the appointment of counsel.

PETITION UNDER 28 U.S.C. § 2254 FOR WRIT OF HABEAS CORPUS BY A PERSON IN STATE CUSTODY

United States District Court District

Name (under which you were convicted): Docket or Case No.:

Place of Confinement: Prisoner No.:

Petitioner (include the name under which you were Respondent (authorized person having custody of petitioner)
convicted)

The Attorney General of the State of

PETITION

    1. (a) Name and location of court that entered the judgment of conviction you are challenging:
        ________________________________________________________________________
        ________________________________________________________________________
        ________________________________________________________________________

(b) Criminal docket or case number (if you know):
________________________________________________________________________

2. (a) Date of the judgment of conviction (if you know):
________________________________________________________________________

(b) Date of sentencing:________________________________________________________________________

3. Length of sentence: ________________________________________________________________________

4. In this case, were you convicted on more than one count or of more than one crime? Yes [ ] No [ ]

    5. Identify all crimes of which you were convicted and sentenced in this case:
        ________________________________________________________________________
        ________________________________________________________________________
        ________________________________________________________________________
        ________________________________________________________________________
        ________________________________________________________________________
        ________________________________________________________________________

6. (a) What was your plea? (Check one)

(1) Not guilty [ ] (3) Nolo contendere (no contest) [ ]

(2) Guilty [ ] (4) Insanity plea [ ]

        (b) If you entered a guilty plea to one count or charge and a not guilty plea to another count or charge, what did you
plead guilty to and what did you plead not guilty to?
        ________________________________________________________________________
        ________________________________________________________________________
        ________________________________________________________________________
        ________________________________________________________________________
        ________________________________________________________________________
        ________________________________________________________________________

7. Did you testify at a pretrial hearing, trial, or a post-trial hearing?
Yes [ ] No [ ]

8. Did you appeal from the judgment of conviction?
Yes [ ] No [ ]

9. If you did appeal, answer the following:

(a) Name of court: ________________________________________________________________________

(b) Docket or case number (if you know):
________________________________________________________________________

        (d) Date of result (if you know):
        ________________________________________________________________________
        (e) Citation to the case (if you know):
        ________________________________________________________________________

        (f) Grounds raised: ________________________________________________________________________
        ________________________________________________________________________
        ________________________________________________________________________
        ________________________________________________________________________
        ________________________________________________________________________
        ________________________________________________________________________

(g) Did you seek further review by a higher state court? Yes [ ] No [ ]

If yes, answer the following:

(1) Name of court: ___________________________________________________________________

(2) Docket or case number (if you know):

___________________________________________________________________

(3) Result: ___________________________________________________________________

(4) Date of result (if you know):
___________________________________________________________________

(5) Citation to the case (if you know):
___________________________________________________________________

        (6) Grounds raised: ___________________________________________________________________
        ___________________________________________________________________
        ___________________________________________________________________
        ___________________________________________________________________
        ___________________________________________________________________
        ___________________________________________________________________

(h) Did you file a petition for certiorari in the United States Supreme Court? Yes [ ] No [ ]
If yes, answer the following:

(1) Docket or case number (if you know):
___________________________________________________________________

(2) Result: ___________________________________________________________________
___________________________________________________________________

(3) Date of result (if you know):
___________________________________________________________________

(4) Citation to the case (if you know):
___________________________________________________________________

10. Other than the direct appeals listed above, have you previously filed any other petitions, applications, or motions
concerning this judgment of conviction in any state court?

Yes [ ] No [ ]

11. If your answer to Question 10 was “Yes,” give the following information:

(a) (1) Name of court: ___________________________________________________________________

(2) Docket or case number (if you know):
___________________________________________________________________

(3) Date of filing (if you know):
___________________________________________________________________

(4) Nature of the proceeding:
___________________________________________________________________

            (5) Grounds raised: ___________________________________________________________________
        ___________________________________________________________________
        ___________________________________________________________________
        ___________________________________________________________________
        ___________________________________________________________________
        ___________________________________________________________________
        ___________________________________________________________________
        ___________________________________________________________________
        ___________________________________________________________________

(6) Did you receive a hearing where evidence was given on your petition, application, or motion?
Yes [ ] No [ ]

(7) Result: ___________________________________________________________________

(8) Date of result (if you
know):___________________________________________________________________

(b) If you filed any second petition, application, or motion, give the same information:

(1) Name of court: ___________________________________________________________________

(2) Docket or case number (if you know):
___________________________________________________________________

(3) Date of filing (if you know):
___________________________________________________________________

(4) Nature of the proceeding:
___________________________________________________________________

            (5) Grounds raised: ___________________________________________________________________
       ___________________________________________________________________
       ___________________________________________________________________
      ___________________________________________________________________
       ___________________________________________________________________
        ___________________________________________________________________
        ___________________________________________________________________
        ___________________________________________________________________
        ___________________________________________________________________

(6) Did you receive a hearing where evidence was given on your petition, application, or motion?
Yes [ ] No [ ]

(7) Result: ___________________________________________________________________

(8) Date of result (if you know):
___________________________________________________________________

(1) Name of court: ___________________________________________________________________

(2) Docket or case number (if you know):
___________________________________________________________________

(3) Date of filing (if you know):
___________________________________________________________________

(4) Nature of the proceeding:
___________________________________________________________________

(5) Grounds raised: ___________________________________________________________________

        _________________________________________________________________
        ___________________________________________________________________
        ___________________________________________________________________
        ___________________________________________________________________
        ___________________________________________________________________
        ___________________________________________________________________
        ___________________________________________________________________
        ___________________________________________________________________

(6) Did you receive a hearing where evidence was given on your petition, application, or motion?
Yes [ ] No [ ]

(7) Result: ___________________________________________________________________

(8) Date of result (if you know):

(d) Did you appeal to the highest state court having jurisdiction over the action taken on your petition, application,
or motion?

(1) First petition: Yes [ ] No [ ]

(2) Second petition: Yes [ ] No [ ]

(3) Third petition: Yes [ ] No [ ]

        (e) If you did not appeal to the highest state court having jurisdiction, explain why you did not:
        ___________________________________________________________________
        ___________________________________________________________________
        ___________________________________________________________________
        ___________________________________________________________________

12. For this petition, state every ground on which you claim that you are being held in violation of the Constitution, laws, or treaties of the United States. Attach additional pages if you have more than four grounds. State the facts supporting each ground.

CAUTION: To proceed in the federal court, you must ordinarily first exhaust (use up) your available state-court
remedies on each ground on which you request action by the federal court. Also, if you fail to set forth all the grounds in this petition, you may be barred from presenting additional grounds at a later date.

GROUND ONE:_____________________________________________________________________________
_____________________________________________________________________________

        (a) Supporting facts (Do not argue or cite law. Just state the specific facts that support your claim.):
        _____________________________________________________________________________
        _____________________________________________________________________________
        _____________________________________________________________________________
        _____________________________________________________________________________
        _____________________________________________________________________________
        _____________________________________________________________________________
        _____________________________________________________________________________
        _____________________________________________________________________________

(b) If you did not exhaust your state remedies on Ground One, explain why:

(1) If you appealed from the judgment of conviction, did you raise this issue?
Yes [ ] No [ ]

            (2) If you did not raise this issue in your direct appeal, explain why:
        ________________________________________________________________________
        ________________________________________________________________________
        ________________________________________________________________________

(d) Post-Conviction Proceedings:

(1) Did you raise this issue through a post-conviction motion or petition for habeas corpus in a state trial court?
Yes [ ] No [ ]

(2) If your answer to Question (d)(1) is “Yes,” state:

    Type of motion or petition: ________________________________________________________________________
    Name and location of the court where the motion or petition was filed:
    ________________________________________________________________________
    ________________________________________________________________________
    Docket or case number (if you know):
    ________________________________________________________________________
    Date of the court's decision: ________________________________________________________________________
    Result (attach a copy of the court's opinion or order, if available):
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________

(3) Did you receive a hearing on your motion or petition?
Yes [ ] No [ ]

(4) Did you appeal from the denial of your motion or petition?
Yes [ ] No [ ]

(5) If your answer to Question (d)(4) is “Yes,” did you raise this issue in the appeal?
Yes [ ] No [ ]

            (6) If your answer to Question (d)(4) is “Yes,” state:
    Name and location of the court where the appeal was filed:
    ________________________________________________________________________
    ________________________________________________________________________
    Docket or case number (if you know):
    ________________________________________________________________________
    Date of the court's decision: ________________________________________________________________________
    Result (attach a copy of the court's opinion or order, if available):
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________

            (7) If your answer to Question (d)(4) or Question (d)(5) is “No,” explain why you did not raise this issue:
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________

        (e) Other Remedies: Describe any other procedures (such as habeas corpus, administrative remedies, etc.) that you have used to exhaust your state remedies on Ground One:
        ________________________________________________________________________
        ________________________________________________________________________
        ________________________________________________________________________

GROUND TWO:_____________________________________________________________________________
_____________________________________________________________________________

        (a) Supporting facts (Do not argue or cite law. Just state the specific facts that support your claim.):
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________

        (b) If you did not exhaust your state remedies on Ground Two, explain why:
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________

(1) If you appealed from the judgment of conviction, did you raise this issue?
Yes [ ] No [ ]

            (2) If you did not raise this issue in your direct appeal, explain why:
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________

(d) Post-Conviction Proceedings:

(1) Did you raise this issue through a post-conviction motion or petition for habeas corpus in a state trial court?
Yes [ ] No [ ]

            (2) If your answer to Question (d)(1) is “Yes,” state:
    Type of motion or petition: ________________________________________________________________________
    Name and location of the court where the motion or petition was filed:
    ________________________________________________________________________
    ________________________________________________________________________
    Docket or case number (if you
    know):________________________________________________________________________
    Date of the court's decision: ________________________________________________________________________
    Result (attach a copy of the court's opinion or order, if available):
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________

(3) Did you receive a hearing on your motion or petition?
Yes [ ] No [ ]

(4) Did you appeal from the denial of your motion or petition?
Yes [ ] No [ ]

(5) If your answer to Question (d)(4) is “Yes,” did you raise this issue in the appeal?
Yes [ ] No [ ]

(e) Other Remedies: Describe any other procedures (such as habeas corpus, administrative remedies, etc.) that you have used to exhaust your state remedies on Ground Two:

GROUND THREE:_____________________________________________________________________________
_____________________________________________________________________________

        (a) Supporting facts (Do not argue or cite law. Just state the specific facts that support your claim.):
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________

        (b) If you did not exhaust your state remedies on Ground Three, explain why:
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________

(1) If you appealed from the judgment of conviction, did you raise this issue?
Yes [ ] No [ ]

            (2) If you did not raise this issue in your direct appeal, explain why:
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________

(d) Post-Conviction Proceedings:

(1) Did you raise this issue through a post-conviction motion or petition for habeas corpus in a state trial court?
Yes [ ] No [ ]

(3) Did you receive a hearing on your motion or petition?
Yes [ ] No [ ]

(4) Did you appeal from the denial of your motion or petition?
Yes [ ] No [ ]

(5) If your answer to Question (d)(4) is “Yes,” did you raise this issue in the appeal?
Yes [ ] No [ ]

    Result (attach a copy of the court's opinion or order, if available):
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________

        (e) Other Remedies: Describe any other procedures (such as habeas corpus, administrative remedies, etc.) that you have used to exhaust your state remedies on Ground Three:
    ________________________________________________________________________
    ________________________________________________________________________

GROUND FOUR:_____________________________________________________________________________
_____________________________________________________________________________

        (a) Supporting facts (Do not argue or cite law. Just state the specific facts that support your claim.):
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________                                     _____________________________________________________________________________

        (b) If you did not exhaust your state remedies on Ground Four, explain why:
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________

(1) If you appealed from the judgment of conviction, did you raise this issue?
Yes [ ] No [ ]

(2) If you did not raise this issue in your direct appeal, explain why:

(d) Post-Conviction Proceedings:

(1) Did you raise this issue through a post-conviction motion or petition for habeas corpus in a state trial court?
Yes [ ] No [ ]

            (2) If your answer to Question (d)(1) is “Yes,” state:
    Type of motion or petition: ________________________________________________________________________
    Name and location of the court where the motion or petition was filed:
    ________________________________________________________________________
    Docket or case number (if you know):
    ________________________________________________________________________
    Date of the court's decision: ________________________________________________________________________
    Result (attach a copy of the court's opinion or order, if available):
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________

(3) Did you receive a hearing on your motion or petition?
Yes [ ] No [ ]

(4) Did you appeal from the denial of your motion or petition?
Yes [ ] No [ ]

(5) If your answer to Question (d)(4) is “Yes,” did you raise this issue in the appeal?
Yes [ ] No [ ]

(e) Other Remedies: Describe any other procedures (such as habeas corpus, administrative remedies, etc.) that you have used to exhaust your state remedies on Ground Four:

13. Please answer these additional questions about the petition you are filing:

(a) Have all grounds for relief that you have raised in this petition been presented to the highest state court having
jurisdiction? Yes [ ] No [ ]

    If your answer is “No,” state which grounds have not been so presented and give your reason(s) for not presenting them:
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________

        (b) Is there any ground in this petition that has not been presented in some state or federal court? If so, which ground or grounds have not been presented, and state your reasons for not presenting them:
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________

14. Have you previously filed any type of petition, application, or motion in a federal court regarding the conviction that
you challenge in this petition? Yes [ ] No [ ]

    If “Yes,” state the name and location of the court, the docket or case number, the type of proceeding, the issues raised,
the date of the court's decision, and the result for each petition, application, or motion filed. Attach a copy of any court
opinion or order, if available.
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________

15. Do you have any petition or appeal now pending (filed and not decided yet) in any court, either state or federal, for the judgment you are challenging? Yes [ ] No [ ]

    If “Yes,” state the name and location of the court, the docket or case number, the type of proceeding, and the issues
raised. ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________

16. Give the name and address, if you know, of each attorney who represented you in the following stages of the judgment you are challenging:

(a) At preliminary hearing: ________________________________________________________________________
________________________________________________________________________

        (b) At arraignment and plea:
    ________________________________________________________________________
    ________________________________________________________________________

(c) At trial: ________________________________________________________________________
________________________________________________________________________

(d) At sentencing: ________________________________________________________________________
________________________________________________________________________

(e) On appeal: ________________________________________________________________________
________________________________________________________________________

        (f) In any post-conviction proceeding:
    ________________________________________________________________________
    ________________________________________________________________________

        (g) On appeal from any ruling against you in a post-conviction proceeding:
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________

17. Do you have any future sentence to serve after you complete the sentence for the judgment that you are challenging? Yes [ ] No [ ]

        (a) If so, give name and location of court that imposed the other sentence you will serve in the future:
    ________________________________________________________________________
    ________________________________________________________________________

        (b) Give the date the other sentence was imposed:
    ________________________________________________________________________
    ________________________________________________________________________

        (c) Give the length of the other sentence:
    ________________________________________________________________________
    ________________________________________________________________________

(d) Have you filed, or do you plan to file, any petition that challenges the judgment or sentence to be served in the
future? Yes [ ] No [ ]

    18. TIMELINESS OF PETITION: If your judgment of conviction became final over one year ago, you must explain why the
one-year statute of limitations as contained in 28 U.S.C. § 2244(d) does not bar your petition.*
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________

* The Antiterrorism and Effective Death Penalty Act of 1996 (“AEDPA”) as contained in 28 U.S.C. § 2244(d) provides in part that:

(1) A one-year period of limitation shall apply to an application for a writ of habeas corpus by a person in custody
pursuant to the judgment of a State court. The limitation period shall run from the latest of--

(A) the date on which the judgment became final by the conclusion of direct review or the expiration of the time
for seeking such review;

(B) the date on which the impediment to filing an application created by State action in violation of the
Constitution or laws of the United States is removed, if the applicant was prevented from filing by such state action;

(C) the date on which the constitutional right asserted was initially recognized by the Supreme Court, if the right
has been newly recognized by the Supreme Court and made retroactively applicable to cases on collateral review; or

(D) the date on which the factual predicate of the claim or claims presented could have been discovered through
the exercise of due diligence.

(2) The time during which a properly filed application for State post-conviction or other collateral review with respect
to the pertinent judgment or claim is pending shall not be counted toward any period of limitation under this subsection.

    Therefore, petitioner asks that the Court grant the following relief:
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________
    or any other relief to which petitioner may be entitled.

___________________________________
Signature of Attorney (if any)

I declare (or certify, verify, or state) under penalty of perjury that the foregoing is true and correct and that this Petition for Writ of Habeas Corpus was placed in the prison mailing system on
____________________________________________________________________________________________(month, date, year).

______________________________________
Executed (signed) on (date).

______________________________________
Signature of Petitioner

    If the person signing is not petitioner, state relationship to petitioner and explain why petitioner is not signing this petition.
    _____________________________________________________________________________
    _____________________________________________________________________________
    _____________________________________________________________________________

IN FORMA PAUPERIS DECLARATION

[Insert appropriate court]

______________________________________ DECLARATION IN

(Petitioner) SUPPORT

OF REQUEST

v. TO PROCEED

______________________________________ IN FORMA

(Respondent(s)) PAUPERIS

I, ______________________________, declare that I am the petitioner in the above entitled case; that in support of my motion to proceed without being required to prepay fees, costs or give security therefor, I state that because of my poverty I am unable to pay the costs of said proceeding or to give security therefor; that I believe I am entitled to relief.

1. Are you presently employed? Yes [ ] No [ ]

a. If the answer is “yes,” state the amount of your salary or wages per month, and give the name and address of your employer.

______________________________________________________________________
______________________________________________________________________

            b. If the answer is “no,” state the date of last employment and the amount of the salary and wages per month which you received.
    ______________________________________________________________________
    ______________________________________________________________________

2. Have you received within the past twelve months any money from any of the following sources?

a. Business, profession or form of self-employment? Yes [ ] No [ ]

b. Rent payments, interest or dividends? Yes [ ] No [ ]

c. Pensions, annuities or life insurance payments? Yes [ ] No [ ]

d. Gifts or inheritances? Yes [ ] No [ ]

e. Any other sources? Yes [ ] No [ ]

    If the answer to any of the above is “yes,” describe each source of money and state the amount received from each during the past twelve months.
    _________________________________________________________________________
    _________________________________________________________________________
    _________________________________________________________________________
    _________________________________________________________________________

        3. Do you own cash, or do you have money in a checking or savings account?
    Yes [ ] No [ ] (Include any funds in prison accounts.)
    If the answer is “yes,” state the total value of the items owned.
    _________________________________________________________________________
    _________________________________________________________________________
    _________________________________________________________________________

        4. Do you own any real estate, stocks, bonds, notes, automobiles, or other valuable property (excluding ordinary household furnishings and clothing)?
    Yes [ ] No [ ]
    If the answer is “yes,” describe the property and state its approximate value.
    _________________________________________________________________________
    _________________________________________________________________________
    _________________________________________________________________________
5. List the persons who are dependent upon you for support, state your relationship to those persons, and indicate how much you contribute toward their support.
    _________________________________________________________________________
    _________________________________________________________________________
    _________________________________________________________________________

I declare (or certify, verify, or state) under penalty of perjury that the foregoing is true and correct. Executed on __________. (date)

______________________________________
Signature of Petitioner

CERTIFICATE

I hereby certify that the petitioner herein has the sum of $______ on account to his credit at the ______ institution where he is confined. I further certify that petitioner likewise has the following securities to his credit according to the records of said ______ institution:

______________________________________
Authorized Officer of Institution