Free Petition for Writ of Habeas Corpus by a Person in Federal Custody under 28 U.S.C. 2241 (pdf) - Wisconsin

Petition for Writ of Habeas Corpus By a Person in Federal Custody (Motion Under 28 U.S.C. § 2241) Instructions - Read Carefully
1. This petition must be readable, either handwritten or typewritten on 8½" x 11" paper, signed by the petitioner under penalty of perjury. Any false statement of a material fact may serve as the basis for prosecution and conviction for perjury. All questions must be answered concisely in the proper space on the form. No notary is required. No citation of authorities need be furnished. If briefs or arguments are submitted, they should be submitted in the form of a separate memorandum. Upon receipt of the filing fee of $5.00, your petition will be filed. If you do not have the necessary filing fee, you may request permission to proceed in forma pauperis, in which event you must execute form AO 240 or any other form required by the court, setting forth information establishing your inability to pay the costs. If you wish to proceed in forma pauperis, you must have an authorized officer at the institution where you are confined complete the certificate as to the amount of money and securities on deposit to your credit in any account in the institution. When you have completed the form, send the original and two identical copies, along with the $5.00 filing fee, to the Clerk of the United States District Court at this address: Clerk, U.S. District Court Western District of Wisconsin PO Box 432 Madison, WI 53701-0432 Retain a copy for your own records. 6. Petitions which do not conform to these instructions may be returned with a notation as to the deficiency.

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3. 4.

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United States District Court Western District of Wisconsin
___________________________________,
(Full name of Prisoner])

____________________________________
(Prisoner I.D. Number)

Case No.______________________
(Provided by clerk of court)

Petitioner, v. ___________________________________,
(Name of W arden, Superintendent, Jailor or authorized person having custody of petitioner)

Respondent.

PETITION FOR WRIT OF HABEAS CORPUS
PURSUANT TO 28 U.S.C. § 2241 BY A PERSON IN FEDERAL CUSTODY I. General Information A. B. Place of confinement: ________________________________________________ Petitioner's institutional address: _______________________________________ __________________________________________________________________

II.

SUBJECT OF THIS PETITION A. Indicate the type of decision or action which you are challenging: __________ __________ __________ __________ __________ __________ __________ Denial of parole Revocation of parole Disciplinary matter Revocation of good time credits Detainer Immigration or deportation order Other (described briefly the type of decision or action involved) ______________________________________________________ ______________________________________________________ ______________________________________________________

B. C.

Who made the decision or took the action? _______________________________ Date of decision or action? ___________________________________________

D.

Was there a hearing of any kind? 1.

Yes (

)

No (

)

First hearing: Date: _______________________________________________________ Location: ____________________________________________________ Conducted by: ________________________________________________ Result: ______________________________________________________ ____________________________________________________________ Second hearing: Date: _______________________________________________________ Location: ____________________________________________________ Conducted by: _______________________________________________ Result: ______________________________________________________ ____________________________________________________________

2.

E.

Were you represented by counsel or a staff member at any hearing? Yes ( ) No ( ) If yes, give name and address: __________________________________________ __________________________________________________________________

III.

PREVIOUS APPEALS/ADMINISTRATIVE REMEDY PROCEDURES A. If your claim concerns a parole matter (for example, denial, modification or revocation of parole) complete the following: 1. Did you appeal the decision to the Regional Commissioner? Yes ( ) No ( ) a. Date of filing appeal: _____________________________________ b. Grounds raised: __________________________________________ _____________________________________________________________ _____________________________________________________________ c. Result and date: __________________________________________ _____________________________________________________________ _____________________________________________________________ 2. Did you appeal the decision to the National Appeals Board/U.S. Parole Commission? Yes ( ) No ( ) a. Date of filing appeal: _____________________________________ b. Grounds raised: __________________________________________ _____________________________________________________________ _____________________________________________________________ c. Result and date: __________________________________________ _____________________________________________________________ _____________________________________________________________

B.

If your claim concerns something other than parole (for example, a disciplinary matter) complete the following about the administrative remedy procedures. (See C.F.R. § 542.10) 1. 2. 3. 4. 5. 6. Did you attempt to resolve your complaint informally? Yes ( ) No ( ) Did you file a formal complaint? Yes ( ) ) No ( No ( ) ) No ( ) ) )

Did you appeal to the Warden? Yes (

Did you appeal to the Regional Commissioner? Yes ( Did you appeal to the General Counsel? Yes ( ) No (

If you did not use the Administrative Remedy Procedure, explain why you did not do so. _________________________________________________ ____________________________________________________________ _____________________________________________________________

C.

Attach copies of your incident report or parole rationale (where appropriate), your request(s) for an administrative remedy and the response(s) you received. If you cannot do so, explain why not. __________________________________________ __________________________________________________________________ ___________________________________________________________________ Have you filed any previous lawsuit(s) related to your present claim? Yes ( ) No ( ) 1. 2. 3. 4. 5. 6. Name and location of court: ______________________________________ Date of filing: _________________________________________________ Case Number: _________________________________________________ Nature of suit: _________________________________________________ Grounds raised: ________________________________________________ _____________________________________________________________ Result and date: _______________________________________________ _____________________________________________________________

D.

IV.

GROUNDS FOR RELIEF State concisely every ground on which you claim that you are being held unlawfully. Summarize briefly the facts supporting each ground. It is not necessary to cite cases or law in this petition. However, if you wish to cite cases or law, you should do so in a separate memorandum or brief. If necessary, you may attach extra page(s) of facts supporting your grounds for relief. A. Ground One: _______________________________________________________ ___________________________________________________________________ Supporting FACTS (tell your story briefly without citing cases or law). __________________________________________________________________ __________________________________________________________________ ___________________________________________________________________ __________________________________________________________________

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ B. Ground Two: _______________________________________________________ ___________________________________________________________________ Supporting FACTS (tell your story briefly without citing cases or law). __________________________________________________________________ __________________________________________________________________ ___________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ Ground Three: _______________________________________________________ ___________________________________________________________________ Supporting FACTS (tell your story briefly without citing cases or law). __________________________________________________________________ __________________________________________________________________ ___________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ Ground Four: _______________________________________________________ ___________________________________________________________________ Supporting FACTS (tell your story briefly without citing cases or law). __________________________________________________________________ __________________________________________________________________ ___________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

C.

D.

V.

REQUEST FOR RELIEF State here exactly what you want the court to do for you. _________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

VI.

DECLARATION UNDER PENALTY OF PERJURY

I, the undersigned, declare (or certify, verify or state) under penalty of perjury, that I am the petitioner in the above action, that I have read the above petition and that the information contained therein is true and correct. 28 U.S.C. § 1746; 18 U.S.C. § 1621. Signed this ___ day of ______________, 20____. __________________________________________ Signature of Petitioner

UNITED STATES DISTRICT COURT WESTERN DISTRICT OF WISCONSIN

______________________________________
Full name of plaintiff(s) or petitioner(s)

Case No. _______________________
(Provided by the clerk of court)

v. ______________________________________
Full name of defendant(s) or respondent(s)

PETITION AND AFFIDAVIT TO PROCEED WITHOUT PREPAYMENT OF FEES AND/OR COSTS I, ____________________________________________, declare that I am the plaintiff or petitioner in the above-named action. In support of my request to proceed in forma pauperis, I declare that I am unable to pay the fees and/or costs of these proceedings and that I am entitled to the relief sought in the complaint/petition/motion. I answer the following questions truthfully and under penalty of perjury (additional pages may be added, if necessary, to provide complete information): I. Personal Information 1) Are you currently incarcerated? G Yes G No

If "No," go to question 2. Complete all sections. If "Yes," answer questions (a), (b) & (c), skip to Section IV. Complete sections IV and V. (a) State the place of your incarceration and provide your prisoner identification number: _______________________________________ (place) (b) (c) Are you employed at the institution? _____________________________ (number) G No G No

GYes

Do you receive any payment from the institution? GYes

If you are a prisoner, attach a printout of your prison trust account statement showing transactions for the six-month period immediately preceding the filing of your complaint, motion, or petition and showing the balance of your release account. Prisoners who are permitted to file in forma pauperis must pay the full filing fee in installments.

(WIWD 01/07)

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Personal Information - continued 2) Are you employed? 3) Are you currently married? If "Yes," is your spouse employed? GYes G Yes G Yes G No G No G No

4) Do you have any legal dependents (children/adults) whom you are responsible for supporting? G Yes G No If "Yes," list them below:
First and Last Initials (For M inor Children Only) or Name Relationship to You Age Amount of Support Provided Per M onth

______________________________ ______________________________ ______________________________

_________________ _________________ _________________

________ ________ ________

$____________ $____________ $____________

II. Income - If you are married, your answers must include your spouse's income.
(When calculating income, you must include any salary, child support, public assistance, unemployment compensation, disability payments, life insurance payments, pensions, annuities, workers' compensation, stock dividends and interest, gifts, and inheritance, or other incoming monies.)

State your total monthly income?

$ ______________

Provide the name of your employer(s): _______________________________________ State your spouse's total monthly income? $ ______________

State the amount of money you have received from any other source in the last twelve months (e.g., rent payments, pension or insurance payments, gifts, inheritance, disability or workers' compensation payments). Please attach an additional sheet if necessary. Source of income ______________________________________________ ______________________________________________ Amount $ ______________________ $ ______________________

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III. Expenses - If you are married and/or have dependents, your expenses should also include your household's expenses.
(When calculating household expenses, you m ay include groceries, clothing, medical costs, utilities which are not included in your rental payments, transportation, and insurance.)

1) Identify the following amounts that you pay per month: G Rent or G Mortgage $ __________________________________ $ __________________________________

Car payment(s)

Alimony and/or court-ordered child support $ __________________________________ Credit card payment(s) $ __________________________________

2) Do you have any other monthly expenses that you have not already identified? G Yes G No If "Yes," list them below: Expense __________________________________ __________________________________ __________________________________ Amount $ __________________________________ $ __________________________________ $ __________________________________ $____________________________

3) What is the total amount of your monthly expenses?

IV. Property - If you are married, your answers must include your spouse's property. 1 ) Do you own a car?
Make and Model _______________________________________________ _______________________________________________

G Yes

G No
Year

If "Yes," list car(s) below:
Approximate Current Value $___________________________ $___________________________

__________ __________

2) Do you own your residence(s)?

G Yes

G No

If "Yes," state the approximate value(s). $ ____________________ What is the amount of equity (assessed value of residence minus outstanding mortgage balance) in the residence(s)? $ ____________________

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IV. Property - continued 3) Do you own any other valuable tangible property, including but not limited to, jewelry, artwork, or antiques? G Yes G No If "Yes," identify the property and approximate value(s).
Property Approximate Value

________________________________________________ ________________________________________________ ________________________________________________

$______________________ $______________________ $______________________ G No

4) Do you have any cash or checking, savings, or other similar accounts? G Yes

If "Yes," state the total amount of such sums. $ ____________________________________ 5) Do you own any intangible property, including but not limited to real estate, stocks, bonds, trusts, or individual retirement accounts (e.g., IRA, 401 k)? G Yes G No If "Yes," state the nature of that property and approximate value(s). ____________________________________________________________________________ V. Other Circumstances - Describe any other financial circumstance(s) that you would like the court to consider when reviewing this petition. ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

___________________________ Date

_________________________________________ Signature - Signed Under Penalty of Perjury

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