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Full Name/Prisoner Number Complete Prison Address (Place of Confinement) IN THE UNITED STATES DISTRICT COURTFOR THE DISTRICT OF NEW MEXICO Civil Action No. (To be supplied by the Court) , Applicant, (Full Name and Prisoner Number) V. . Respondent, (Name of Warden, Superintendent, jailor or authorized person having custody of applicant) (Do not use et al.) and The Attorney General of the State of , Additional Respondent. APPLICATION FOR A WRIT OF HABEAS CORPUS PURSUANT TO 28 U.S.C. § 2254 BY A PERSON IN STATE CUSTODY Clear Form Note: If the applicant is attacking a judgment which imposed a sentence to be served in the future, applicant must fill in the name of the state whe re the judgment of conviction was entered. If the applicant has a sentence to be served in the future under a federal judgment, which he/she wishes to attack, he/she should file a mo tion under 28 U.S.C. § 2255, in the federal court which entered the judgment. CONVICTION UNDER ATTACK Name and location of the court which entered the judgment of conviction under 1) attack Date judgment of conviction was entered 2) Case number 3) Type and length of sentence imposed 4) Are you presently serving a sentence imposed for a convi ction other than the 5) No conviction under attack in this motion? Yes Nature of the offense involved (all counts) 6) What was your plea? (check one) 7) Nolo Contendere Guilty Not Guilty If you entered a guilty plea to one count or indictment, an d a not guilty plea to another court or indictment, give details: If you entered a plea of guilty pursuant to a plea bargain, st ate the terms and 8) conditions of the agreement Judge only Jury Kind of trial (check one) 9) N o 10) Did you testify at trial? Yes 2 DIRECT APPEAL Did you appeal from the judgment of conviction? Yes No 11) . If you did appeal, give the name and location of the court w here the appeal was filed, 12) the result, the case number and date of the court's decision (or attach a copy of the court's opinion or order): If you did not appeal, explain briefly why you did not: 13) No Did you seek permission to file a late appeal? Yes a) POST-CONVICTION PROCEEDINGS 14) Other than a direct appeal from the judgment of convictio n and sentence, have you previously filed any petitions, applications, or motions with respect to this judgment in any No Yes court, state or federal? If your answer to 14 was ''Yes,'' give the following info rmation: 15) FIRST petition, application or motion. a) 1. Name of court 2. Nature of proceeding 3. Claims raised 4. Did you receive an evidentiary hearing on your petition, application or motion? Yes No 5. Result 6. Date of result 3 7. Did you appeal the result to the highest state court having jurisdiction? Yes If you did appeal, give the name of the court where the No appeal was filed, the result, the case number, citation and date of the court's decision (or attach a copy of the court's opinion or orde r) If you did not appeal, briefly explain why you did not 8. b) As to any SECOND petition, application or motion, giv e the following information: Name of court 1. Nature of proceeding 2. Claims raised 3. Did you receive an evidentiary hearing on your petition, application or 4. N o motion? Yes Result 5. Date of result 6. 7. Did you appeal the result to the highest state court havin g jurisdiction? If you did appeal, give the name of the court where the No Yes appeal was filed, the result, the case number, citation and date of the court's decision (or attach a copy of the court's opinion or orde r) 4 If you did not appeal, briefly explain why you did not 8. . c) As to any THIRD petition, application or motion, give the following information: Name of court 1. Nature of proceeding 2. Claims raised 3. Did you receive an evidentiary hearing on your petition, application or 4. No motion? Yes Result 5. Date of result 6. Did you appeal the result to the highest state court havin g jurisdiction? 7. If you did appeal, give the name of the court where the YesNo appeal was filed, the result, the case number, citation and date of the court's decision (or attach a copy of the court's opinion or orde r) If you did not appeal, briefly explain why you did not 8. CLAIMS 16) State concisely every claim that you are being held un lawfully. Summarize briefly the facts supporting each claim. If necessary, you may attach extra pages stating additional claims and supporting facts. You should raise in this petiti on all claims for relief which relate to the conviction under attack. In order to proceed m federal court, you ordinarily must exha ust the remedies available to you m the state courts as to each claim on which you r equest action by the federal court. 5 Claim One: (1) Supporting Facts: (Without citing legal authorities or argument state briefly the facts in of this claim) (2) Statement of exhaustion of state remedies as to claim one: Direct Appeal (a) If you appealed from the judgment of conviction, did you rai se this issue? Yes No (b) If you did not raise this issue in your direct appeal, expla in briefly why you did not Post-Conviction Proceedings (c) Did you raise this issue by means of a post-conviction motion or petition No for habeas corpus in a state trial court? Yes (d) If your answer to (c) is ''Yes,'' state the type of motion or petition, the name and location of the court where the motion or pet ition was filed, the case number (if known), the result and the date of the court's de cision (e) Did you receive an evidentiary hearing on your motion or petition? Yes No 6 (f) Did you appeal from the denial of your motion or petition? YesNo (g) If your answer to (f) is ''Yes,'' state whether this i ssue was raised in the appeal, Yes No . and state the name and location of the court where t he appeal was filed, the case number and the date of the cour t's decision (or attach a copy of the court's opinion or order) (h) If your answer to question (e), (f) or (g) is ''No,'' briefl y explain Other Remedies (i) Describe all other procedures (such as habeas corpus in the state supreme court, administrative remedies, etc.) you have used to exha ust your state remedies as to the issue Claim Two: (1) Supporting Facts: (Without citing legal authorities or argume nt state briefly the facts in of this claim) 7 (2) Statement of exhaustion of state remedies as to claim two: Direct Appeal (a) If you appealed from the judgment of conviction, did you rai se this issue? Yes No (b) If you did not raise this issue in your direct appeal, expla in briefly why you did not Post-Conviction Proceedings (c) Did you raise this issue by means of a post-conviction motion or petition No for habeas corpus in a state trial court? Yes (d) If your answer to (c) is ''Yes,'' state the type of mot ion or petition, the name and location of the court where the motion or pet ition was filed, the case number (if known), the result and the date of the court's de cision (e) Did you receive an evidentiary hearing on your motion or petition? Yes No (f) Did you appeal from the denial of your motion or petitio n? Yes No (g) If your answer to (f) is "Yes,'' state whether this is sue was raised in the appeal, Yes No , and state the name and location of the court where t he appeal was filed, the case number and the date of the cour t's decision (or attach a copy of the court's opinion or order) (h) If your answer to question (e), (f) or (g) is ''No," briefly explain 8 Other Remedies (i) Describe all other procedures (such as habeas corpus in the state supreme court, administrative remedies, etc.) you have used to exha ust your state remedies as to the issue Claim Three: (1) Supporting Facts: (Without citing legal authorities or argume nt state briefly the facts in of this claim) (2) Statement of exhaustion of state remedies as to claim three: Direct Appeal (a) If you appealed from the judgment of conviction, did you rai se this issue? Yes No (b) If you did not raise this issue m your direct appeal, explai n briefly why you did not Post-Conviction Proceedings (c) Did you raise this issue by means of a post-conviction motion or petition No for habeas corpus in a state trial court? Yes 9 (d) If your answer to (c) is ''Yes,'' state the type of motion or petition, the name and location of the court where the motion or pet ition was filed, the case number (if known), the result and the date of the court's de cision . (e) Did you receive an evidentiary hearing on your motion or petition? YesNo (f) Did you appeal from the denial of your motion or petitio n? No Yes (g) If your answer to (f) is ''Yes,'' state whether this i ssue was raised in the No appeal, Yes . and state the name and location of the court where t he appeal was filed, the case number and the date of the cour t's decision (or attach a copy of the court's opinion or order) (h) If your answer to question (e), (f) or (g) is ''No,'' briefl y explain Other Remedies (i) Describe all other procedures (such as habeas corpus in the state supreme court, administrative remedies, etc.) you have used to exha ust your state remedies as to the issue 17) Have all claims for relief raised in this petition be en presented to the highest state No court having jurisdiction? Yes 10 18) If you answered ''No'' to question 17, state which claims have not been so presented and briefly give your reasons(s) for not presenting them 19) If any of the claims listed in this application were n ot previously presented in any other court, state or federal, state briefly what claims we re not so presented, and give your reasons for not presenting them 20) Have you previously filed any type of petition, applicatio n or motion in a federal court No regarding the conviction under attack? Yes If ''Yes,'' answer the following and attach a copy of the court's decision for each petition, application, or motion filed: Name and location of court a) Type of proceeding b) The issues raised C) The result d) SUCCESSIVE APPLICATIONS This court is required to dismiss any claim presented in a second or successive petition that the federal court of appeals has authorized to be filed unl ess the applicant shows that each claim satisfies the requirements of 28 U.S.C. § 2244, as amended by Tide I of the Antiterrorism and Effective Death Penalty Act of 1996, P ub. L. No. 104-132, § 106, 1 10 Stat. 1214 (Apr. 24, 1996). 21) If you are raising a claim which you have not presented in a prior application, have you obtained an order from the United States Court of Appeals for the Tenth Circuit authorizing No Please attach a copy of the this district court to consider the application? Yes order. 11 22) Do you have any petition, application, motion or appeal now pending in any court, If ''Yes,'' either state or federal, regarding the conviction under a ttack? Yes No state the name of the court, case file number (if known ), and the nature of the proceeding LEGAL REPRESENTATION 23) 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 (b) At arraignment and plea (c) At trial (d) At sentencing (e) On appea l (f) In any post-conviction proceeding (g) On appeal from any adverse ruling in a post-conviction pro ceeding OTHER CONVICTIONS 24) Were you sentenced on more than one count of an indictment or on more than one No indictment, in the same court and at the same time? Yes 12 .. 25) Do you have any future sentence to serve after you com plete the sentence imposed by No the judgment under attack? Yes . (a) If so, give name and location of court which imposed se ntence to be served in the future (b) and give date and length of service to be served in the future (c) Have you filed, or do you contemplate filing, any petiti on attacking the judgment which imposed the sentence to be served in the future? Yes No Wherefore, applicant prays that the court grant him such relief to which he may be entitled in this proceeding. Applicant's Original Signature Signature of Attorney (if any) Attorney's Full Address and Telephone Number DECLARATION UNDER PENALTY OF PERJURY The undersigned declares under penalty of perjury that he/she is the applicant in this action, that he/she has read this petition and that th e information contained in the petition is true and correct. 28 U. S. C. § 1746; 18 U. S. C. § 162 1. o n Executed at (Date) (Location) Applicant's Original Signature 13