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OAO 241

(Rev. 5/85)

PETITION UNDER 28 USC § 2254 FOR WRIT OF HABEAS CORPUS BY A PERSON IN STATE CUSTODY (If petitioner is attacking a judgment which imposed a sentence to be served in the future, petitioner must fill in the name o f the state where the judgment was entered. If petitioner has a sentence to be served in the future under a federal judgment which he wishes to attack, he should file a motion under 28 USC § 2255, in the federa l court wh ich entere d the judg ment.) PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN STATE CUSTODY Instruction s­Read Carefully

(1) This petition must be legibly handwritten or typewritten, and signed by the petitioner under p enalty of perjury. A ny 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. (2) Additional pages are not permitted except with respect to the facts which you rely upon to support your grounds for relief. No citation of authorities need be furnished. If briefs or arguments are submitted, they should be submitted in the form of a separate memorandum. (3) Upon receipt of a fee of $5 your p etition will be filed if it is in proper order. (4) If you do not have the necessary funds for transcripts, counsel, appeal, and other costs connected with a motion of this type, you may request permission to proceed in forma pau peris, in which event you m ust execute form AO 24 0 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 paupe ris, you must have an authorized officer at the penal institution complete the certificate as to the amount of money and securities on deposit to your credit in any account in the institution. If your person account exceeds $ , you m ust pay the filing fee as re quired b y the rules o f the district co urt. (5) Only judgmen ts entered by one court may be cha llenged in a single motion. If you seek to challenge judgments entered by differe nt courts eith er in the sam e state or in d ifferent states, y ou mu st file separate p etitions as to ea ch cour t. (6) Your attention is directed to the fact that you must include all grounds for relief and all facts supporting such grounds for relief in the petition you file seeking relief from any judgment of conviction. (7) When the petition is fu lly completed, the original and at least two copies must be mailed to the Clerk of the United States District Cou rt whose address is

(8) Petitions which do not conform to these instructions will be returned with a notation as to the deficiency.

AO 241

(Rev. 5/85)

PETITION UNDER 28 USC § 2254 FOR WRIT OF HABEAS CORPUS BY A PERSON IN STATE CUSTODY

United States District Court
Name Place of Confinement

District Prisoner No. Case No.

Name of Petitioner ( include name under which convicted) V. The Attorney Gene ral of the State of:

Name of Respondent (authorized person ha ving custody of pe titioner)

PETITION
1. Name and location of court which entered the judgment of conviction under attack

2. 3. 4.

Date of judgment of conviction Length of sentence Nature of offen se involved (all cou nts)

5.

What was your plea? (Check one) (a) Not g uilty G (b) Guilty (c) Nolo contendere

G G

If you entered a guilty plea to one co unt or indictme nt, and a not gu ilty plea to another cou nt or indictmen t, give details:

6.

If you pleaded not guilty, what kind of trial did you have? (Check one) (a) Jury G (b) Judg e only

G

7.

Did yo u testify at the tria l? Yes G No G Did you appeal from the judgment of conviction? Yes G No G (2)

8.

AO 241

(Rev. 5/85)

9.

If you did appeal, answer the following: (a) Name of court (b) Resu lt (c) Date of result and citation, if known (d) Grounds raised

(e) If you sought further review of the decision on appeal by a higher state court, please answer the following: (1) Name of court (2) Resu lt

(3) Date of result and citation, if known (4) Grounds raised

(f) If you filed a petition fo r certiorari in th e United States Sup reme C ourt, please answer the follow ing with re spect to each dire ct appeal: (1) Name of court (2) Resu lt

(3) Date of result and citation, if known (4) Grounds raised

10.

Other than a direct appeal from the judgme nt of conviction a nd sentence, ha ve you pre viously filed any p etitions, application s, or motio ns with res pect to this jud gmen t in any co urt, state or fed eral? Yes G No G If your answer to 10 was "yes," give the following information: (a) (1) Name of court (2) Nature of proceeding

11.

(3) Grounds raised

(3)

AO 241

(Rev. 5/85)

(4) Did you receive an evidentiary hearing on your petition, application or motion? Yes G No G (5) Resu lt (6) Date o f result (b) As to any second petition, application or motion give the same information: (1) Name of court (2) Name of proceeding

(3) Grounds raised

(4) Did you receive an evidentiary hearing on your petition, application or motion? Yes G No G (5) Resu lt (6) Date o f result (c) Did you appe al to the highest state court having jurisdiction the result of action taken on any petition, application or motion? (1) First petition, etc. Yes G No G (2) Second petition, etc. Yes

G

No

G

(d) If you did not appeal from the adverse action on any petition, application or motio n, explain briefly w hy you did not:

12.

State concisely every ground on which you claim that you are being held unlawfully. Summarize briefly the facts supporting each ground. If necessary, you may attach pages stating additional grounds and facts supporting same. C A U T I O N: In order to proceed in the federal court, you must ordinarily first exhaust your available state court remedies as to each ground on which you request action by the federal court. If you fail to set forth all gr ounds in this petition, you may be barred from presenting additional grounds at a later date. (4)

AO 241

(Rev. 5/85)

For your info rmation , the follow ing is a list of the m ost frequently raised grounds for relief in habeas corpus proceeding s. Each statement preceded by a letter constitutes a separate ground for possible relief. You may raise any grounds which you may have other than those listed if you have exhausted your state court remedies with respect to them. However, you sho uld raise in this petition all available grounds (relating to this conviction) on which you base your allegations that you are being held in custody unlawfully. Do not check any of these listed grounds. If you select one or more of th ese ground s for relief, you mu st allege facts. The petition w ill be returned to you if you merely check (a) throu gh (j) or any on e of these groun ds. (a) Conviction obtained by plea of guilty which was unlawfully induced or not made voluntar ily with understanding of the nature of the charge and the consequences of the plea. (b) Conviction obtained by use of coerced confession. (c) Conviction obtained by use of evidence gained pursuant to an unconstitutional search and seizure. (d) Conv iction obta ined by use of ev idence o btained p ursuant to an unlaw ful arrest. (e) Conviction obtained by a violation of the privilege against self-incrimination. (f) Conviction obtained by the unconstitutional failure of the prosecution to disclose to the defendant evidence favorab le to the defe ndant. (g) Conviction obtained by a violation of the protection against double jeopardy. (h) Conviction obtained by action of a grand or petit jury which was unconstitutionally selected and impaneled. (i) Denial o f effective a ssistance of c ounsel. (j) Denial o f right of ap peal. A. Ground one:

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

B.

Ground two:

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

(5)

AO 241

(Rev. 5/85)

C.

Ground three:

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

D. Groun d four:

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

13.

If any of th e groun ds listed in 12 A, B, C, an d D we re not pre viously p resented in any oth er court, state or federa l, state briefly what grounds were not so presented, and give your reasons for not presenting them:

14.

Do you have any petition or appeal now pending in any court, either state or federal, as to the judgment under attack? Yes G No G Give the name and address, if known, of each attorney who represented you in the following stages of the judgment attacked herein: (a) At preliminary hearing

15.

(b) At arraignment and plea

(6)

AO 241

(Rev. 5/85)

(c) At trial

(d) At sentencing

(e) On app eal

(f) In any post-conviction proceeding

(g) On appeal from any adverse ruling in a post-conviction proceeding

16.

Were you sentenced on mo re than on e count o f an indictm ent, or on more th an one in dictmen t, in the same court and at the same time? Yes G No G Do you have any future sentence to serve after you complete the sentence imposed by the judgment under attack? Yes G No G (a) If so, give n ame an d location of court w hich im posed se ntence to be served in the futur e:

17.

(b) Give da te and len gth of the above se ntence:

(c) Have you filed, or do you contemplate filing, any petition attacking the judgment which imposed the sentence to be served in the future? Yes G No G Wherefore, petitioner prays that the Court grant petitioner relief to which he may be entitled in this proceeding.

Signature of Attorney (if any)

I declare under penalty of perjury that the foregoing is true and correct. Executed on

Date

Signature of Petitioner

(7)