Free Microsoft Word - Form 5 APPLICATION FOR POST-CONVICTION RELIEF.co-defendant. - South Carolina

FORM 5 STATE OF SOUTH CAROLINA ) ) County of __________________________ ) ) __________________________________ ) Full name and prison number (if any) of Applicant ) ) v. ) ) ) State of South Carolina ) ) ) ) IN THE COURT OF COMMON PLEAS

APPLICATION FOR POST-CONVICTION RELIEF

INSTRUCTIONS B READ CAREFULLY
In order for this application to receive consideration by the Court, it shall be in writing (legibly handwritten or typewritten), signed by the applicant and verified (notarized), and it shall set forth in concise form the answers to each applicable question. If necessary, applicant may furnish his answer to a particular question on the reverse side of the page or on an additional page. Applicant shall make clear to which question any such continued answer refers. Since every application must be sworn under oath, any false statement of a material fact therein may serve as the basis of prosecution and conviction for perjury. Applicants should, therefore, exercise care to assure that all answers are true and correct. If the application is taken in forma pauperis, it shall include an affidavit (attached at the back of the form) setting forth information which establishes that applicant will be unable to pay the fees and costs of the proceedings. When the application is completed, the original shall be mailed to the Clerk of Court for the County in which the applicant was convicted.

1. 2. 3. 4.

Place of detention ________________________________________________________ _______________________________________________________________________ Name and location of Court which imposed sentence ____________________________ _______________________________________________________________________ Name(s) of co-defendant(s) (if any) The indictment number or numbers (if known) upon which and the offenses for which sentence was imposed: (a) (b) _________________________________________________________________ _________________________________________________________________ 1

(c) 5. (a) (b) (c) 6. (a) (b) (c) 7. 8.

_________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ after a plea of guilty ________________________________________________ after a plea of not guilty _____________________________________________ after a plea of nolo contendere ________________________________________

The date upon which sentence was imposed and the terms of the sentence:

Check whether a finding of guilty was made:

Did you appeal from the judgment of conviction or the imposition of sentence? _______________________________________________________________________ If you answered Ayes@ to (7), list: (a) i. ii. iii. (b) i. ii. iii. (c) i. ii. iii. (d) i. ii. iii. the name of each Court to which you appealed: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ the result in each such Court to which you appealed: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ the date of each such result: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ if known, citations of any written opinion or orders entered pursuant to such results: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________

9.

If you answered Ano@ to (7), state your reasons for not so appealing: (a) (b) _________________________________________________________________ _________________________________________________________________ 2

(c) 10.

_________________________________________________________________

State concisely the grounds on which you base your allegation that you are being held in custody unlawfully: (a) (b) (c) _________________________________________________________________ _________________________________________________________________ _________________________________________________________________

11.

State concisely and in the same order the facts which support each of the grounds set out in (10): (a) (b) (c) _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ any petition in a State Court under South Carolina Law?____________________ any petition in State or Federal Courts for habeas corpus or post-convictions relief? ___________________________________________________________ (c) (d) any petition in the United States Supreme Court for certiorari other than petitions, if any, already specified in (8)? ________________________________________ any other petitions, motions or applications in this or any other Court? _________

12.

Prior to this application have you filed with respect to this conviction: (a) (b)

13.

If you answered Ayes@ to any part of (12), list with respect to each petition, motion or application: (a) i. ii. iii. iv. (b) i. ii. iii. iv. the specific nature thereof: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ the name and location of the Court in which each was filed: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ 3

(c) i. ii. iii. iv. (d) i. ii. iii. iv. (e) i. ii. iii. iv. 14.

the disposition thereof: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ the date of each such disposition: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ if known, citations of any written opinions or orders entered pursuant to each such disposition: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________

Has any ground set forth in (10) been previously presented to this or any other Court, State or Federal, in any petition, motion or application which you have filed? _______________________________________________________________________ _______________________________________________________________________

15.

If you answered "yes" to (14) identify: (a) i. ii. iii. (b) i. ii. iii. which grounds have been presented: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ the proceedings in which each ground was raised: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________

Revised 3/2003

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16.

If any ground set forth in (10) has not previously been presented to any Court, State or Federal, set forth the ground and state concisely the reasons why such ground has not previously been presented: (a) (b) (c) ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ your arraignment and plea? __________________________________________ your trial, if any? __________________________________________________ your sentencing? __________________________________________________ your appeal, if any, from the judgment of conviction or the imposition of sentence? ________________________________________________________ (e) preparation, presentation or consideration of any petitions, motions or applications with respect to this conviction, which you filed?

17.

Were you represented by an attorney at any time during the course of: (a) (b) (c) (d)

18.

If you answered Ayes@ to one or more parts of (17), list: (a) i. ii. iii. (b) i. ii. iii. the name and address of each attorney who represented you: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ the proceedings at which each such attorney represented you: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________

Revised 3/2003

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19.

State clearly the relief you seek in filing this application: _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________

20.

Are you now under sentence from any other court that you have not challenged? _______________________________________________________________________ _______________________________________________________________________

STATE OF SOUTH CAROLINA

) ) County of __________________________ )

VERIFICATION

I, _____________________________________________________________, being duly sworn upon my oath, depose and say that I have subscribed to the foregoing application; that I know the contents thereof; that it includes every ground known to me for vacating, setting aside or correcting the conviction and sentence attacked in this application; and that the matters and allegations therein set forth are true. __________________________________________ SWORN to and subscribed before me this __________ day of ____________________________, ________. _______________________________________ (L.S.)
Notary Public

My Commission Expires: _______________________

Revised 3/2003

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APPLICATION TO PROCEED WITHOUT PAYMENT OF COSTS AND AFFIDAVIT IN SUPPORT THEREOF I, ___________________________________________________, hereby apply for leave to proceed in this action without prepayment of fees or costs or security therefor. In support of my application I declare under penalty of perjury that the following facts are true: (1) (2) I am the applicant in this action and I believe I am entitled to redress. Because of my poverty I am unable to pay the costs of said proceeding or give security thereof. ________________________________________
Applicant

SWORN or affirmed to and subscribed before me this _______ day of ___________________, ________. __________________________________________
Notary Public

My Commission Expires: _______________________

Revised 3/2003

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