Fill and Sign the Application Commutation Clemency Form

Application for Pardon/Commutation STATE OF MINNESOTA BOARD OF PARDONS Applicant: THIS APPLICATION IS A SWORN AFFIDAVIT. MISPREPRESENTATION OF FACTS CAN/WILL DISQUALIFY YOU. 1. Applicant  was tried and convicted of _____________________________________________________  Pled guilty to (offense) On__________________ in _____________________County __________________________________Court in the (Date) (Municipal - county - district) City of _______________________, Minnesota. The court sentenced applicant to_____________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ (Describe terms and conditions of sentence) 2. Applicant was discharged from the sentence on _________________ and has been law-abiding since that time. (Date) 3. The following individuals were involved in the criminal proceeding for the above-noted offense(s): Name of trial judge Address City, State, Zip Code Name of prosecuting attorney Address City, State, Zip Code Name of defense attorney Address City, State, Zip Code Name of victim (if known) Address City, State, Zip Code 4. Applicant’s full and correct name, date of birth, birthplace, and aliases are: Applicant’s full and true name (last, first, middle) Date of birth (month, day, year) Birthplace Aliases (list all names under which applicant may be known) 5. Applicant’s occupancy and residence during the five years immediately proceeding conviction (use another sheet of paper if necessary) Dates Address City, State, Zip Code 6. Please list any other offense(s) for which you have been convicted, indicted, arrested: Date Offense County/State _____________________ _______________________________ ___________________________________ _____________________ _______________________________ ___________________________________ 7. MN Stat. 638.06 subd.4 requires that an applicant provide the Board of Pardons a “succinct statement of the evidence adduced at trial, with the endorsement of the judge or county attorney who tried the case that the statement is substantially correct. If this statement and endorsement are not furnished, the reason for failing to furnish them shall be stated.” Failure to comply wit this section may disqualify your application. ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 8. Applicant has initiated the following actions to challenge his/her conviction and/or sentence: Appeal of conviction Post conviction action Appeal sentence Habeas Corpus action 9. The grounds for the challenge (s) were: 10. The decision(s) of the court(s) in each of the above actions was (were): 11. Applicant was represented by: Self (pro se) Private attorney (Name) Public defender. (Name) 12. Applicant asks that a Pardon Commutation be granted on the following grounds: Innocence Entrapment Inadequate counsel Unfair trial Excessive sentence in light of plea bargain Excessive sentence in light of that given accomplice Institutional adjustment Personal situation 13. The following facts support applicant’s position that a Pardon or Commutation should be granted: I hereby declare under oath that all of the information provided on this application is true and correct. I also authorize any agency or individual in Minnesota or any other local, state or federal unit of government to provide to staff of the Minnesota Board of Pardons any and all information relating to my application including records of arrests and convictions. Finally, I agree that all information on this application and any information obtained by Board of Pardons staff shall be considered public data under the Minnesota Government Data Practices Act. Respectfully submitted, Applicant’s Signature Address City, State, Zip Code Telephone (Include area code) Date Note: Additional pages may be Return to: Minnesota Board of Pardons added or the reverse side 1450 Energy Park Drive, Suite 200 of this sheet may be used St. Paul, Minnesota 55108-5219 by the applicant, if necessary 651/642-0284 to complete the application. Subscribes and sworn to before me this_________day of ___________, 20___. __________________________________ Notary