Fill and Sign the 9 10 14a Requires the Proper Use of This Form

Revised�9�10 �14 � � I NMATE FORM FOR WRIT OF HABEAS CORPUS I NSTRUCTIONS – R EAD CAREFULLY (NOTE: O.C.G.A. §9- 10-14(a) requires the proper use of this form, and failure to use this form as required will result in the clerk of any court refusing to accept the action for filing.) 1. Any action filed by an inmate of a state or local pena l or correctional institution against the state or a local government or against any agency or officer of a state or local government must be filed on the appropriate form or forms promulgated by the Administrative Office of the Courts of Georgia. 2. This application must be legibly handwritten or type written, and signed by the petitioner. Any false statement of a material fact may serve as the basis for prosecution for perjury. All questions must be answered concisely in the proper space on the form. 3. Any inmate may submit with the complaint or other in itial pleading any additional matter in any form if the pleading includes the form or forms at tached hereto. Material attached to the forms should be legibly handwritten, typewritten, or copied. 4. Upon receipt of the appropriate filing fee or if per mission to proceed in forma pauperis has been granted, your petition will be filed if it is in proper order. 5. If the inmate wishes to file an affidavit of in digency, it must be accompanied by a certification from the institution wherein the inmate is incarcerated that the financial statement correctly states the amount of funds in any and all custodial accounts held with the institution. 6. O.C.G.A. §42 -12 -1 et seq. provides that an inmate’s institutional account shall be frozen, and funds seized for court costs and fees. Additionally, the fil ing of frivolous litigation shall result in a deduction from the account. 7. Any action brought pur suant to this article shall be filed within one year in the case of a misdemeanor, except as otherwise provided in Co de Section 40-13 -33, or within four years in the case of a felony, other tha n one challenging a conviction for which a death sentence has been imposed or challenging a sentence of death. O.C.G.A. §9 -14 -42(c). 8. Any Inmate Form for Writ of Habeas Corpus which does not conform to these instructions will be returned with a notation as to the deficiency. 9. These forms may be obtaine d at the Administrative Office of the Courts’ website ( http:// www.georgiacourts.gov/index.php/court -forms/101 ) or from the Administrative Office of the Courts through the head of the institution in which t he inmate is incarcerated. Administrative�Office�of�the�Courts�(Revised�9�10 �14) � [1 ]�� � � � � � Form�HC�1� IN THE SUPERIOR COURT OF ___________________________ STATE OF GEORGIA ____________________________________ , Petitioner ____________________________________ , Civil Action No. _____________ ____________ Inmate Number vs. ____________________________________ , Habeas Corpus Warden ____________________________________ , Respondent (Name of Institution where you are now located) PART I: BACKGROUND INFORMATION ON YOUR CONVICTION 1. Name, county, and court which entered the judgment of conviction under attack: _________________________________________________________________________________ 2. Date of conviction: _______________________________ __________________________________ (Please Note: O.G.C.A. § 9 -14 -42(c) mandates that applications for writ of habeas corpus must be filed within a certain time. Please see Instructions (7) for more information. ) 3. Length of sentence(s): __________________________________________________________ _____ 4. Were you sentenced on more than one count of an indictment, or on more t han one indictment, in the same court and at the same time? Yes No 5. Name of offense(s). List all counts: _____________________________________________________ ___________________________________________________ _______________________________ 6. What was your plea? Please check one: Guilty Guilty but mentally ill Nolo conte ndere Not guilty If you entered a guilty plea to one count or indictment, and a not guilty or nolo con tendere plea to another count or indictment, give details: __________________________ ______________________ ____ ______________________________________________________________________________ ___________________________________________________ _______________________________ 7. Kind of trial. Please check one: Jury Judge only 8. Did you testify at the trial? Yes No APPLICATION FOR WRIT OF HABEAS CORP US Administrative�Office�of�the�Courts�(Revised�9�10 �14) � [2 ]�� � � � � � Form�HC�1� 9. Did you appeal from the conviction? Yes No 10. If you did appeal, answer the following: Name of appellate court to which you appealed: ________ __________________________________ Result of appeal: ________________________ Date of result: ___________________________ 11. Other than a direct appeal from the judgment of conviction and sentenc e, have you previously filed any petitions, applications, or motions with respect to this conviction in a ny state or federal court? Yes No 12. If your answer to 11 was “Yes,” give the following information: ( Note: If more than three petitions, please use a separate shee t of paper and use the same format to list them.) A. Name of court and case number: ____________________________________________________ What kind of case or action was this? ______________ __________________________________ All grounds raised (at tach extra sheet of paper if necessary) : ______________________ _______ ______________________________________________________________________________ ______________________________________________________________________________ Did a judge hear th e case? Yes No Did witnesses testify? Yes No Name of Judge: _____________________________________ ____________________________ Result: ____________________________________________ ____________________________ Date of Result: _____________________ ____________________________________________ B. As to any second petition, application or motion, gi ve the same information. Name of court and case number: ____________________________________________________ What kind of case or action was this? ________________________________________________ All grounds raised (attach extra sheet of paper if n ecessary) : _____________________________ ______________________________________________________________________________ ______________________________________________________________________________ Did a judge hear the case? Yes No Did witnesses testify? Yes No Name of Judge: _____________________________________ ____________________________ Result: _______________________________________ _________________________________ Date of Result: ____________________________________ _____________________________ C. As to any third petition, application or motion, giv e the same information. Name of court and case number: ____________________________________________________ What kind of case or action was this? ______________ __________________________________ Administrative�Office�of�the�Courts�(Revised�9�10 �14) � [3 ]�� � � � � � Form�HC�1� All grounds raised (attach extra sheet of paper if n ecessary) : _____________________________ ______________________________________________________________________________ ______________________________________________________________________________ Did a judge hear the case? Yes No Did witnesses testify? Yes No Name of Judge: _____________________________________ ____________________________ Result: ____________________________________________ ____________________________ Date of Result: ____________________________________ _____________________________ D. Did you appeal to the Georgia Supreme Court or the Georgi a Court of Appeals from the result taken on any petition, application, or motion listed above? First petition, application or motion: Yes No Second petition, application or motion: Yes No Third petition, application or motion: Yes No E. If you did not appeal from the denial of relief on any petition, application or motion, explain briefly why you did not: __________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ F. If you appealed to the highest state court having juri sdiction, did you file a petition for certiorari in the United States Suprem e Court to review the denial of your petition by the Georgia Supreme Court or the Georgia Court of Appeals? Yes No 13. Do you have any petition or appeal now pending in any court, either state or federal, as to the conviction under attac k? Yes No 14. Give the name and address, if known, of each attorney who represente d you in the following stages of the judgment attacked herein: At preliminary hearing: ____________________________________ _________________________ __________________________________________________ _______________________________ At arraignment and plea: ___________________________________ _________________________ ___________________________________________________ ______________________________ At trial: ________________________________________________ __________________________ ___________________________________________________ ______________________________ At sentencing: ____________________________________ ________________________________ ___________________________________________________ ______________________________ On appeal: ____________________________________________ ___________________________ ____________________________________ _____________________________________________ In any post -conviction proceeding: _________________________________ ___________________ ___________________________________________________ ______________________________ On appeal from an y adverse ruling in a post -conviction proceeding: __________________________ Administrative�Office�of�the�Courts�(Revised�9�10 �14) � [4 ]�� � � � � � Form�HC�1� ___________________________________________________ ______________________________ 15. Do you have any other sentence, either state or federal, to serve after you complete the sentence imposed by the conviction under attack? Yes No If so, give the name and location of the court(s) which impose any other sen tence: ___________________________________________________ ______________________________ __________________________________________________ _______________________________ State the date and length of any other sentence to be served: ___________ ______________________ ___________________________________________________ ______________________________ Have you filed, or do you contemplate filing, any petition attacking the judgment( s) which imposed any other sentence? Yes No Administrative�Office�of�the�Courts�(Revised�9�10 �14) � [5 ]�� � � � � � Form�HC�1� PART II: STATEMENT OF YOUR CLAIMS State concisely every ground on which you now claim that you are being held unlawfully. Summarize briefly the facts supporting each ground. If necessary, you may attach pa ges stating additional grounds and facts supporting the same. 1. GROUND ONE: ______________________________________________ ________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ SUPPORTING FACTS. (Tell your story briefly without citing c ases or law): _______________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 2. GROUND TWO: _____________________________________________ _________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ � SUPPORTING FACTS. (Tell your story briefly without citing cases or law): _______________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 3. GROUND THREE: ___________________________________________ _________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ � SUPPORTING FACTS. (Tell your story briefly without citing cases or law): _______________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ � 4. GROUND FOUR: _____________________________________________ ________________________ Administrative�Office�of�the�Courts�(Revised�9�10 �14) � [6 ]�� � � � � � Form�HC�1� _____________________________________________________________________________________ _____________________________________________________________________________________ � SUPPORTIN G FACTS. (Tell your story briefly without citing cases or law): _______________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ � Administrative�Office�of�the�Courts�(Revised�9�10 �14) � [7 ]�� � � � � � Form�HC�1� PART III: OTHER CLAIMS NOT PRESENTED TO A COURT BEFORE THIS If any of the grounds listed in PART II were not previous ly presented in any other court, state or federal, state briefly what grounds were not so presented, and give your reasons for not pre senting them: � _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ � � Wherefore, petitioner prays that the Court grant rel ief to which the petitioner may be entitled in this proceeding. ______________________________ _____________ Date ______________________________ ______________________________ Signature and Address of Petitioner’s Attorney (if any attorney) I declare (or certify, verify, or state) under penalty of pe rjury that the foregoing statements made in this Application for Writ of Habeas Corpus ar e true and correct. Executed on _______________________ Date _____________________________________________ Signature of Petitioner Sworn to and subscribed before me this _______ day of ______________, 20____. ___________________________________________________ Notary Public or Other Person Authorized to Administer Oa ths Please note that under O.C.G.A. §9 -14 -45 service of a petition of habeas corpus shall be made upon the person having custody of the petitione r. If you are being detained under the custody of the Georgia Department of Corrections, an ad ditional copy of the petition must be served on the Attorney General of Georgia. If you are being detained under the custody of some authority other than the Georgia Department of Cor rections, an additional copy of the petition must be served upon the district attorney o f the county in which the petition is filed. Service upon the Attorney General or the district attorney may be had by mailing a copy of the petition and a proper certificate of service. �