Free 2241 Habeas Corpus Petition Form - Florida

UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF FLORIDA DIVISION

§ 2241 HABEAS CORPUS PETITION FORM
TO BE USED BY PRISONERS IN ACTIONS UNDER 28 U.S.C. § 2241
OR IN ACTIONS CHALLENGING REMOVAL PROCEEDINGS

, Inmate/Alien # .

.
(Enter full name of Petitioner, prison number or alien [A] number, if applicable, AND address of place of confinement.)

vs. , , , , .
(Enter name and title of each Respondent. If additional space is required, use the blank area below and directly to the right.)

CASE NO: (To be assigned by Clerk)

ALL APPLICANTS MUST COMPLETE THIS ENTIRE FORM

ANSWER ALL OF THE FOLLOWING:
1. This petition concerns (check where applicable): (a). (b). (c). (d). (e). (f). 2.

G G G G G G

a conviction a sentence prison disciplinary action or other action resulting in lost gain time credits parole immigration/removal other (explain):

Provide the following information regarding the conviction(s) and sentence(s) for which you are presently incarcerated: (a). Name(s) and location(s) of court: (b). Case Number(s): (c). Charge(s) for which you were convicted:

(d). What was your plea? (1) Not Guilty (2) Guilty (3) Nolo contendere

(Check one) G G G Yes

(e). Did you appeal from the judgment of conviction? 3. If you did appeal, answer the following: (a) Name of Court: (b) Result: (c) Date of opinion and mandate (citation, if known):

G

No G

Case #:

4.

Claims that challenge your conviction or imposition of sentence can only be raised by motion under 28 U.S.C. § 2255 unless the § 2255 motion is inadequate or ineffective to test the legality of your detention. If any of the grounds raised above challenge your conviction or sentencing: (a) Have you filed a motion under 28 U.S.C. § 2255? Yes G No G If yes, please provide the case #, where filed, relevant date(s), and the results:

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(b). Explain why the remedy under § 2255 was or is inadequate or ineffective:

5.

Are you currently represented by counsel in this case or in any other court case? Yes G No G If yes, please explain:

6.

If this case concerns removal proceedings: (a) Date of final order of removal: (b) Did you file an appeal with the Board of Immigration Appeals? Yes

G

No G

7. In the spaces below, set forth every ground which supports your claim that you are incarcerated unlawfully. Briefly summarize the specific facts in support of each ground raised. Conclusions that are not supported by specific facts are insufficient. You may attach additional pages if necessary to raise additional grounds or provide additional facts. Do not cite any law in your statement of facts. (a). Ground one:

Supporting FACTS (state briefly without citing cases or law):

Exhaustion: [1] - Have you presented ground one to the Bureau of Prisons, either through the prison grievance system or other administrative proceeding? Yes G No G If yes, please provide the results of the proceeding(s) and the relevant date(s). Include any appeals:

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[2]-(Answer only if you are challenging an issue related to removal (immigration) proceedings) - Did you present ground one to the Board of Immigration Appeals? Yes G No G If yes, please provide the results of the proceeding(s) and the relevant date(s).

(b). Ground two:

Supporting FACTS (state briefly without citing cases or law):

Exhaustion: [1] - Have you presented ground two to the Bureau of Prisons, either through the prison grievance system or other administrative proceeding? Yes G No G If yes, please provide the results of the proceeding(s) and the relevant date(s). Include any appeals:

[2]-(Answer only if you are challenging an issue related to removal (immigration) proceedings) - Did you present ground two to the Board of Immigration Appeals? Yes G No G If yes, please provide the results of the proceeding(s) and the relevant date(s).

(c). Ground three:

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Supporting FACTS (state briefly without citing cases or law):

Exhaustion: [1] - Have you presented ground three to the Bureau of Prisons, either through the prison grievance system or other administrative proceeding? Yes G No G If yes, please provide the results of the proceeding(s) and the relevant date(s). Include any appeals:

[2]-(Answer only if you are challenging an issue related to removal (immigration) proceedings) - Did you present ground three to the Board of Immigration Appeals? Yes G No G If yes, please provide the results of the proceeding(s) and the relevant date(s).

(d). Ground four:

Supporting FACTS (state briefly without citing cases or law):

Exhaustion: [1] - Have you presented ground four to the Bureau of Prisons, either through the prison grievance system or other administrative proceeding? Yes G No G

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If yes, please provide the results of the proceeding(s) and the relevant date(s). Include any appeals:

[2]-(Answer only if you are challenging an issue related to removal (immigration) proceedings) - Did you present ground four to the Board of Immigration Appeals? Yes G No G If yes, please provide the results of the proceeding(s) and the relevant date(s).

8.

WHEREFORE, based upon the grounds raised above, Petitioner prays that the court will grant the following relief:

DECLARATION I declare under penalty of perjury that I have read the above and the information contained herein is true and correct. ________________________ (Date) __________________________________________ Signature of Petitioner IF MAILED BY PRISONER: I declare or state under penalty of perjury that this petition was (check one):

G delivered to prison officials for mailing, or G deposited in the prison's internal mail system on:
(date).

__________________________________________ Signature of Petitioner
Revised 07/02

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