Fill and Sign the Certificate of Rehabilitation Andor Governors Pardon Faq Form

1 Instructions A Pardon is not a right but a discretionary duty of the Governor that can be denied for any reason. An applicant for Pardon should understand that the process will take several months, even a year or more in some instances. The Parole Board will review all applications. After the Parole Board makes the review and recommendation, you will be notified. Please, do not call the Parole Board concerning results. The Governor relies on the recommendation of the Parole Board and will not review any application, which has not been first reviewed by the Parole Board. The Governor does not review files taken out of order. There is no appeal process for Pardons. If the Governor denies the application, that decision is final. Follow all instructions and answer all questions truthfully. Incorrect information will be grounds for return of your application. Return all applications to: DCC Institutional Release Services (IRS) Pardon Department 2801 S. Olive St., Suite 6-D Pine Bluff, AR. 71601 ******************************************************************************* 2 Pardon Application Institutional Release Services--Pardon Department 2801 S. Olive St., Suite 6-D Pine Bluff, AR. 71601 870-543-1033 // 870-879-6725 fax Name _______________________________ Date of Birth_______________________ Address______________________________ Race ______________Sex_____________ City_________________________________ ADC# ____________PID#____________ State ______________Zip________________ SS#_______________________________ Phone________________________ Cell_______________________ I am requesting the following (Check Only One) ________Pardon (with firearm rights restored) ________ Pardon (without firearm rights restored) ________Restoration of Firearms Only -- crime must be 8 years old and no weapons involved (page 8 also must be filled out by Sheriff in county where you reside and notarized) Checklist for Applicant’s Use Please make sure all information listed below is attached to application 1. _______First time applicant Yes ______No_______ Date of previous application ____________________ 2. _______Entirely completed, signed, dated and notarized application 3. _______Judgment Orders for each conviction to be considered 4. _______Letters of recommendation: (include current address and daytime phone #’s) i. Family ii. Friends iii. Minister (if applicable) iv. Present or former employers v. Other reputable persons in the community who may desire to testify to the moral character and good behavior of the applicant. 6. ________Letter of Personal Plea *************************************************************************** 3 1. Give full name under which you were convicted and any alias names you may have used: ___________________________________________________________________________ ____________________________________________________________________________ 2. You must list below, ALL CRIMES WHICH YOU WISH TO BE PARDONED! (Attach separate sheet if necessary to include all convictions to be considered) (fill out completely and attach Judgment OR Commitment Orders (or docket sheets) for each crime listed) Crime County of conviction Date Court Docket # Sentence 3. Have you completely discharged from your sentence? YES__________NO ___________ 4. Are you on probation or suspended sentence? ______________________________ 5. Was any restitution ordered in any of the convictions Yes _______ No ________ 6. Have all fines, fees, court costs and restitution been paid in full? If Yes—attach receipts If you still owe restitution, cost(s) and/or fine(s) for any crimes you were convicted, please list the persons or entity to which the debt is owed and the outstanding amount still owed. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 7. Were there victims in your crimes? YES _______NO ________ If yes answer the following questions; a. Did you know the victim? ____________________________________________ b. If yes, what was the relationship? ______________________________________ c. Was the victim injured? _____________________________________________ d. Age of the Victim __________________________________________________ e. Was the victim law enforcement or public official? ________________________ f. Was there more than one (1) victim? ____________________________________ 8. Were other persons involved in the crimes listed above? Yes ______No ________ If yes, list the names of your accomplices and what, if any, sentences they received ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 4 9. Concerning the facts of the crimes, briefly explain what happened in each case. (Attach a separate sheet if necessary) _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _____________________________________________________________________________ 10. Explain the reason why you think the Governor should grant to you the relief requested. (Attach a separate sheet if necessary) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 11. Describe what you have done to demonstrate your rehabilitation-Community programs, volunteer work, furthering education, speaking engagements, mentoring to others, etc. (Attach a separate sheet if necessary) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 12. Are you a SEX OFFENDER that is currently required to register by law? Yes____ No ____ (If your answer is yes, answer the following questions) >. Has your registration been kept current since it’s requirement? ____________________ >. If no, explain why not ____________________________________________________ You must submit your most recent risk assessment with this application. This may be obtained from your local sheriff’s office) 13. List all other crimes not listed before, even out of state crimes, traffic violations, misdemeanors, etc. that you DO NOT WISH TO BE CONSIDERED FOR PARDON Crime County of conviction Date Court Docket # Sentence 5 PERSONAL BACKGROUND 1. Are you: Single____ Married _____ Separated ______ Divorced _______ Widowed __________ Full name of spouse ___________________________________________________ When were you married________________________________________________ Where were you married _______________________________________________ 2. Previous marriages: list the following information; Name of Spouse Date of Marriage Date marriage ended Reason( divorce/death, etc .) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 3. Children ________ How many? __________ Name AGE Address ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ 4. Have you ever served in the Armed Forces? Yes_________ No __________ If yes, what branch? ________________________________________________ 5. What type of discharge did you receive? Honorable ________ Dishonorable _________ Medical __________ Other _______________ EDUCATIONAL BACKGROUND School Address Dates of Attendance Highest grade completed & Degrees 6 EMPLOYMENT BACKGROUND 1. Please provide the following information about your current job; Name of employer ____________________________________________________________ Employer’s address ___________________________________________________________ When were you hired__________________________________________________________ Give a brief description of your job duties: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 2. If you are currently unemployed, but on disability, please explain how you became disabled. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ For previous jobs you have held, list the following information Dates From To Employer Address & Current Phone ******************************************************************************* By signing and submitting this application, I hereby swear and affirm that the information provided is true and accurate to the best of my knowledge and I hereby waive any state or federal privacy protections or other privileges to the extent allowable by law; I understand that incorrect information provided by myself, will be grounds for IMMEDIATE DENIAL! Applicant’s Signature Date of Application Subscribed and sworn to me this _______________day of __________, ________ My Commission expires:: ______________________ _____________________________________________ Notary Public 7 Certificate to Obtain Information To be filled out by the Clerk in the County of Conviction In the Court of Conviction (Circuit Court of District Court) I, ___________________________Circuit Clerk or District Clerk of ________________County Have been approached by _____________________________(applicant’s name) in an attempt to obtain a certified copy of his or her commitment orders for the purpose of applying for a Governor’s Pardon. After a good faith effort, a copy of these records cannot be furnished for the following reason: ___________Case too old, documents have been destroyed ___________A copy has been diligently searched for and cannot be found ___________Court House burnt and record was destroyed (year of _________) ___________Record has been Sealed (if applicant applies in person, sealed record must be supplied to them) ***** Statute 16-90-903**** ******************************************************************************* ___________________________________ Circuit Clerk/ Deputy Clerk / District Clerk ___________________________________ County Seal 8 COMPLETE THIS PAGE ONLY IF APPLYING FOR ************RESTORATION OF FIREARM RIGHTS ********** ***********************ONLY************************** Recommendation of Chief Law Enforcement Officer in County of Residence I, __________________________________________________________, hereby recommend (applicant)_________________________________ for the restoration of his/her right to own or possess firearms and certify that he/she is of good standing and is deserving of this restoration of firearm rights. In Accordance with Arkansas Code Annotated ~5-73-103, I confirm that the crime occurred more than eight (8) years ago and no weapon was involved in the commission of the crime. This person currently resides at _____________________________________which is within my jurisdiction and has lived within my jurisdiction since _________________________. Sheriff ___________________________________ County of _________________________________ Subscribed and sworn to me this __________day of _____________, ________. ___________________________ Notary Public My commission expires: ______________________________ Executive Clemency Arkansas Applications should not be submitted from probationers or parolees that have not fully discharged their sentence. If there is still probation or parole time left on a sentence pardons have not typically been granted. Process: 1. To apply fill out and return application to parole services as listed on the application. If your mailing address is different than your home address, please include both. *Please note that inmates must request applications from and return them to their institutional parole officer. 2. Include letters of support or recommendation. 3. Full application will be sent to Governor’s office. 4. Parole Board will place the application on their agenda and make a non-binding recommendation to the Governor. The Governor’s decision is a final decision. 5. Once the Parole Board makes their recommendation, they will notify the applicant and post the results on their website. 6. They will forward the file to the Governor’s office approximately 30 days from the listing on the website. 7. Once the application is received in the Governor’s office, he has 240 days for consultation, recommendation and final decision to be made. 8. Appointment may be made with the Governor’s Legal Counsel for Clemency and Corrections once the application has reached the Governor’s office. Outcomes: There are several possible outcomes when application is made. 1. The Governor may take no action on an application. In this case, the applicant may re-apply on their own time frame. They are not barred from re-application for any statutory amount of time. 2. The Governor may deny the application. This will result in two outcomes: 1. Most applicants will be denied for 4 years from the date of application. 2. Inmates with a sentence of life in prison without parole will be denied for 6 years from the date of denial These are statutorily set denial periods. 3. The Governor may issue a notice of intent to grant a pardon or commutation. This will trigger a 30 day waiting period for public comment and public notice that a clemency action is pending. At the end of the 30 day waiting period, a proclamation will be issued granting the pardon or commutation. Issuance of a notice of intent is not an automatic grant. If for any reasons, information is received during the 30 day waiting period that is negative, the Governor can choose not to grant the pardon or commutation. Restoration: If an applicant is granted a pardon, he or she may have all their rights restored. If the applicant has felony convictions, the pardon will restore the right to bear arms. If the applicant has a misdemeanor conviction, with the exception of domestic battery convictions, there was never a loss of the second amendment rights. If an applicant is granted a commutation, the time they are to serve in the Department of Corrections will be shortened. This is not a full pardon and does not restore rights that have been lost. A full pardon must be asked for at a future date for full restoration. Contact with the Governor’s office: Amy Click Assistant Legal Counsel for Clemency and Corrections State Capitol Room 011 Little Rock, AR 72201 501-683-6447