CV-76 (0 7/06)LETTER ENCLOSING HABEAS CORPUS FORMS
SHERRI R. CARTERDistrict Court Executive and
Clerk of Court
UNITED STATES DISTRICT COURT
CENTRAL DISTRICT OF CALIFORNIA
WESTERN DIVISION 312 North Spring Street, Room G-8
Los Angeles, CA 90012Tel: (213) 894-7984 SOUTHERN DIVISION411 West Fourth Street, Suite 1053 Santa Ana, CA 92701-4516 (714) 338-4750
EASTERN DIVISION3470 Twelfth Street, Room 134Riverside, CA 92501(951) 328-4450
Dear Sir/Madam:
The following documents are enclosed:
1. Petition for Writ of Habeas Corpus by a Person in:GFederal Custody (Form CV-27) (four copies) along with one copy of Title 28 U.S. Code
Sections 2241 and 2242
G State Custody (Form CV-69) (four copies) along with one copy of Title 28 U.S. Code
Sections 2244(d), 2254 and Rules Governing Section 2254 Cases
2. Local Rules 72-3, and 83-16
The judges of this court, pursuant to General Order 171, have adopted fo\
r use the enclosed
Petition for Writ of Habeas Corpus form. You must comply with its requirements and instructions.
Read the instructions carefully. When the form is completed in every detail, return the original
and two copies to this office and keep the last copy.
The filing fee for a Petition for Habeas Corpus is $5.00, payable to: Clerk, U.S. District Court.
Please remit a cashier’s check, certified bank check, business or corporate che\
ck, government issued
check, or money order drawn on a major America bank or the United States Postal Service. The Clerk’s
Office will also accept credit cards (Mastercard/Visa, Discover, American Express) for filing fees and
miscellaneous fees. Credit card payments may be made at all payment windows where receipts are
issued.
If you are without funds , execute the Declaration to Proceed in Forma Pauperis contained
within the form.
In addition to the declaration, an authorized officer of the institution\
must complete the
Certificate contained in the Declaration to Proceed in Forma Pauperis as to how much money the
institution has on deposit in your account.
Sincerely,
Clerk, U. S. District Court
By
Deputy Clerk
UNITED STATES CODE SECTIONS
UNITED STATES DISTRICT COURT
CENTRAL DISTRICT OF CALIFORNIAUNITED STATES CODE SECTIONS
TITLE 28 § 2241 & 2242PAGE 1 of 2TITLE 28 UNITED STATES CODE
§ 2241. POWER TO GRANT WRIT
(a) Writs of habeas corpus may be granted by the Supreme Court, any justice thereof, the
district courts and any circuit judge within their respective jurisdictions. The order of a circuit judge
shall be entered in the records of the district court of the district wherein the restraint complained
of is had.
(b) The Supreme Court, any justice thereof, and any circuit judge may decline to entertain
an application for a writ of habeas corpus and may transfer the application for hearing and
determination to the district court having jurisdiction to entertain it.
(c) The writ of habeas corpus shall not extend to a prisoner unless--
(1) He is in custody under or by color of the authority of the United States or is
committed for trial before some court thereof; or
(2) He is in custody for an act done or omitted in pursuance of an Act of Congress,
or an order, process, judgment or decree of a court or judge of the United States; or
(3) He is in custody in violation of the Constitution or laws or treaties of the United
States; or
(4) He, being a citizen of a foreign state and domiciled therein is in custody for an act
done or omitted under any alleged right, title, authority, privilege, protection, or exemption claimed
under the commission, order or sanction of any foreign state, or under color thereof, the validity and
effect of which depend upon the law of nations; or
(5) It is necessary to bring him into court to testify or for trial.
(d) Where an application for a writ of habeas corpus is made by a person in custody under
the judgment and sentence of a State court of a State which contains two or more Federal judicial
districts, the application may be filed in the district court for the district wherein such person is in
custody or in the district court for the district within which the State court was held which convicted
and sentenced him and each of such district courts shall have concurrent jurisdiction to entertain the
application. The district court for the district wherein such an application is filed in the exercise of
its discretion and in furtherance of justice may transfer the application to the other district court for
hearing and determination.
UNITED STATES CODE SECTIONS
UNITED STATES DISTRICT COURT
CENTRAL DISTRICT OF CALIFORNIAUNITED STATES CODE SECTIONS
TITLE 28 § 2241 & 2242PAGE 2 of 2§ 2242. APPLICATION
Application for a writ of habeas corpus shall be in writing signed and verified by the person for
whose relief it is intended or by someone acting in his behalf.
It shall allege the facts concerning the applicant's commitment or detention, the name of the person
who has custody over him and by virtue of what claim or authority, if known.
It may be amended or supplemented as provided in the rules of procedure applicable to civil actions.
If addressed to the Supreme Court, a justice thereof or a circuit judge it shall state the reasons for not
making application to the district court of the district in which the applicant is held.
LR 83-16 Revision 12/01/2003LOCAL CIVIL RULE 83-16LOCAL RULES
UNITED STATES DISTRICT COURT
CENTRAL DISTRICT OF CALIFORNIA
LOCAL RULE 83-16 HABEAS CORPUS PETITIONS AND MOTIONS UNDER 28 U.S.C.
SECTION 2255
83-16.1 COURT FORMS - A petition for a writ of habeas corpus or a motion filed
pursuant to 28 U.S.C. Section 2255 shall be submitted on the forms approved and supplied by the
Court.
83-16.2 VERIFICATION - OTHER THAN PERSON IN CUSTODY - If the petition or
motion is verified by a person other than the individual in custody, the person verifying the document
shall set forth the reason why it has not been verified by the person in custody. The person verifying
the document shall allege only facts personally known to that person. If facts are alleged upon
information and belief, the source of the information and belief shall be stated.
83-16.3 HABEAS CORPUS - EXCLUSION, DEPORTATION AND REMOVAL
CASES - A next friend petition for a writ of habeas corpus in exclusion, deportation and removal
cases must allege that the petitioner has been authorized by the applicant for admission or respondent
in the proceedings to file the petition. If the petition is filed by a relative who is the father, mother,
husband, wife, brother, sister, uncle or aunt of the applicant for admission in the proceedings, that
fact shall be alleged and authorization to file the petition need not be shown.
LOCAL RULES
UNITED STATES DISTRICT COURT
CENTRAL DISTRICT OF CALIFORNIA
LR 72-3 Revision 12/01/2003LOCAL CIVIL RULE 72-3LOCAL RULE 72-3 DISPOSITIVE MOTIONS AND PRISONER PETITIONS
72-3.1 DUTIES OF MAGISTRATE JUDGE - Upon the assignment of a case
covered by F.R.Civ.P. 72, the Magistrate Judge shall conduct all necessary proceedings. Pursuant
to Rule 10 of the Rules Governing Section 2254 Cases in the United States District Courts, the duties
imposed upon a Judge of the District Court may be performed by a full-time Magistrate Judge
(except in death penalty cases).
72-3.2 SUMMARY DISMISSAL OF HABEAS CORPUS PETITION - The
Magistrate Judge promptly shall examine a petition for writ of habeas corpus, and if it plainly
appears from the face of the petition and any exhibits annexed to it that the petitioner is not
entitled to relief, the Magistrate Judge may prepare a proposed order for summary dismissal and
submit it and a proposed judgment to the District Judge.
72-3.3 REPORT BY MAGISTRATE JUDGE - In habeas cases that are not
summarily dismissed, and in all other matters covered by F.R.Civ.P. 72(b) that the Magistrate
Judge determines can be resolved without trial, the Magistrate Judge shall file a report which
may contain proposed findings of fact, conclusions of law and recommendations for disposition.
If the Magistrate Judge concludes that a trial by a District Judge is required, the Magistrate Judge
shall so report to the District Judge.
72-3.4 OBJECTIONS TO REPORT WHERE PARTY IN CUSTODY - If a party
is in custody at the time of the filing of the Magistrate Judge’s report, the time for filing
objections allowed under F.R.Civ.P. 72(b) shall be twenty (20) days or such further time as the
Magistrate Judge may order.
72-3.5 DETERMINATION OF OBJECTIONS BY DISTRICT JUDGE - If no
objections are filed within the time allowed, the Magistrate Judge shall submit the matter to the
District Judge on the basis of the original report. If objections are timely filed, the Magistrate
Judge may issue a revised or supplemental report or submit the matter to the District Judge on
the basis of the original report.
72-3.6 FILING OF TRANSCRIPT - If an evidentiary hearing was conducted by
the Magistrate Judge, the party objecting shall obtain and file a certified transcript of the hearing
or pertinent part thereof. Upon application, the Magistrate Judge may extend the time to file the
transcript.
PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN FEDERAL CUSTODY (28 U.S.C § 2241)
CV-27 (02/05)Page 1 of 7NAMEPRISON IDENTIFICATION/BOOKING NO.ADDRESS OR PLACE OF CONFINEMENTNote:If represented by an attorney, provide name, address & telephone
number. It is your responsibility to notify the Clerk of Court in
writing of any change of address.
UNITED STATES DISTRICT COURT
CENTRAL DISTRICT OF CALIFORNIAFULL NAME (Include name under which you were convicted)
Petitioner,v.NAME OF WARDEN, (or other authorized person having custody of
petitioner)
Respondent.CASE NUMBER:
CVTo be supplied by the Clerk of the United States District Court
CRCriminal case under which sentence was imposed.
PETITION FOR WRIT OF HABEAS CORPUS BY
A PERSON IN FEDERAL CUSTODY
(28 U.S.C § 2241)
INSTRUCTIONS - READ CAREFULLY
This petition shall be legibly handwritten or typewritten, signed by the petitioner, under penalty of perjury. You must set forth
CONCISELY the answer to each question in the proper space on the form. Any false statement of a material fact may serve
as the basis for prosecution and conviction for perjury.
You must not attach separate pages to this petition except that ONE separate additional page is permitted in answering
Question No.9.
Upon receipt of a fee of $5.00 your petition will be filed if it is in proper order.
If you are seeking leave to proceed in forma pauperis (without paying the $5.00 filing fee and other court costs), then you
must also execute the declaration on the last page, setting forth information which establishes your inability to pay the fees
and costs of the proceedings or to give security therefor. If you wish to proceed in forma pauperis, 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 prison account exceeds $25.00, you must pay the filing fee as required by the
rule of the district court.
When the petition is completed, the original and 3 copies, must be mailed to the Clerk of the United States District Court for
the Central District of California, United States Courthouse, 312 North Spring Street, Los Angeles, California 90012,
ATTENTION: Intake/Docket Section.
Only one sentence, conviction or parole matter may be challenged in a single petition. If you challenge more than one, you
must do so by separate petitions.
PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN FEDERAL CUSTODY (28 U.S.C § 2241)
CV-27 (02/05)Page 2 of 7PLEASE COMPLETE THE FOLLOWING: (Check appropriate number)
This petition concerns:
1. G a conviction.
2. G a sentence.
3. G jail or prison conditions.
4. G prison discipline.
5. G a parole problem.
6. G other.
PETITION
1.Place of detention 2.Name and location of court which imposed sentence 3.The indictment number or numbers (if known) upon which, and the offense or offenses for which, sentence was
imposed:
a. b. c. 4.The date upon which sentence was imposed and the terms of the sentence:
a. b. c. 5.Check whether a finding of guilty was made:
a. G After a plea of guilty
b. G After a plea of not guilty
c. G After a plea of nolo contendere
6. If you were found guilty after a plea of not guilty, check whether that finding was made by:
a. G a jury
b. G a judge without a jury
7. Did you appeal from the judgment of conviction or the imposition of sentence? G Yes G No
8.If you did appeal, give the following information for each appeal:
CAUTION:If you are attacking a sentence imposed under a federal judgment, you must first file a direct appeal or
motion under 28 U.S.C. §2255 in the federal court which entered the judgment.
a.(1) Name of court (2) Result (3) Date of result (4) Citation or number of opinion
PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN FEDERAL CUSTODY (28 U.S.C § 2241)
CV-27 (02/05)Page 3 of 7(5)Grounds raised (list each):
(a)(b)(c)(d)b.(1)Name of court (2) Result (3)Date of result (4)Citation or number of opinion (5) Grounds raised (list each):
(a)(b)(c)(d)9.State CONCISELY every ground on which you claim that you are being held unlawfully. Summarize briefly the
facts supporting each ground. If necessary, attach a SINGLE page only behind this page.
CAUTION:If you fail to set forth all grounds in this petition, you may be barred from presenting additional
grounds at a later date. You must state facts, not conclusions in support of your grounds. A rule of
thumb to follow is - who did exactly what to violate your rights at what time and place.
a.Ground one: Supporting FACTS (tell your story BRIEFLY without citing cases or law): b.Ground two: Supporting FACTS (tell your story BRIEFLY without citing cases or law):
PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN FEDERAL CUSTODY (28 U.S.C § 2241)
CV-27 (02/05)Page 4 of 7c.Ground three: Supporting FACTS (tell your story BRIEFLY without citing cases or law): d. Ground four: Supporting FACTS (tell your story BRIEFLY without citing cases or law): 10.Have you filed previous petitions for habeas corpus, motions under Section 2255 of Title 28, United States Code, or
any other applications, petitions or motions with respect to this conviction? G Yes G No
11.If your answer to Question No. 10 was yes, give the following information:
a.(1)Name of Court (2)Nature of proceeding (3)Grounds raised (4)Result (5)Date of result (6)Citation or number of any written opinions or orders entered pursuant to each disposition.
PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN FEDERAL CUSTODY (28 U.S.C § 2241)
CV-27 (02/05)Page 5 of 7b.(1)Name of Court (2)Nature of proceeding (3)Grounds raised (4)Result (5)Date of result (6)Citation or number of any written opinions or orders entered pursuant to each disposition.12.If you did not file a motion under Section 2255 of Title 28, United States Code, or if you filed such a motion and it
was denied, state why your remedy by way of such motion is inadequate or ineffective to test the legality of your
detention: 13.Are you presently represented by counsel? G YesG No
If so, provide name, address and telephone number Case name and court 14.If you are seeking leave to proceed in forma pauperis, have you completed the declaration setting forth the required
information? G YesG No
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 (or certify, verify, or state) under penalty of perjury that the foregoing is true and correct.
Executed on DateSignature of Petitioner
PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN FEDERAL CUSTODY (28 U.S.C § 2241)
CV-27 (02/05)Page 6 of 7PetitionerRespondent(s)DECLARATION IN SUPPORT
OF REQUEST
TO PROCEED
IN FORMA PAUPERIS
I, , declare that I am the petitioner in the above entitled
case; that in support of my motion to proceed without being required to prepay fees, costs or give security therefor, I state
that because of my poverty I am unable to pay the costs of said proceeding or to give security therefor; that I believe I am
entitled to relief.
1.Are you presently employed? G Yes G No
a.If the answer is yes, state the amount of your salary or wages per month, and give the name and address of your
employer. b.If the answer is no, state the date of last employment and the amount of the salary and wages per month which
you received. 2.Have you received, within the past twelve months, any money from any of the following sources?
a.Business, profession or form of self-employment?G Yes G No
b.Rent payments, interest or dividends?G Yes G No
c.Pensions, annuities or life insurance payments?G Yes G No
d.Gifts or inheritances?G Yes G No
e.Any other sources?G Yes G No
If the answer to any of the above is yes, describe each source of money and state the amount received from each
during the past twelve months: 3.Do you own any cash, or do you have money in a checking or savings account? (Include any funds in prison
accounts)G Yes G No
If the answer is yes, state the total value of the items owned: 4. Do you own any real estate, stocks, bonds, notes, automobiles, or other valuable property? (Excluding ordinary
household furnishings and clothing) G Yes G No
If the answer is yes, describe the property and state its approximate value:
PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN FEDERAL CUSTODY (28 U.S.C § 2241)
CV-27 (02/05)Page 7 of 75.List the persons who are dependent upon you for support, state your relationship to those persons, and indicate how
much you contribute toward their support: I, declare (or certify, verify or state) under penalty of perjury that the foregoing is true and correct.
Executed on DateSignature of Petitioner
CERTIFICATE
I hereby certify that the Petitioner herein has the sum of $ on account to his credit
at the institution where
he is confined. I further certify that Petitioner likewise has the following securities to his credit according to the records of
said institution:DateAuthorized Officer of InstitutionTitle of Officer
PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN FEDERAL CUSTODY (28 U.S.C § 2241)
CV-27 (02/05)Page 1 of 7NAMEPRISON IDENTIFICATION/BOOKING NO.ADDRESS OR PLACE OF CONFINEMENTNote:If represented by an attorney, provide name, address & telephone
number. It is your responsibility to notify the Clerk of Court in
writing of any change of address.
UNITED STATES DISTRICT COURT
CENTRAL DISTRICT OF CALIFORNIAFULL NAME (Include name under which you were convicted)
Petitioner,v.NAME OF WARDEN, (or other authorized person having custody of
petitioner)
Respondent.CASE NUMBER:
CVTo be supplied by the Clerk of the United States District Court
CRCriminal case under which sentence was imposed.
PETITION FOR WRIT OF HABEAS CORPUS BY
A PERSON IN FEDERAL CUSTODY
(28 U.S.C § 2241)
INSTRUCTIONS - READ CAREFULLY
This petition shall be legibly handwritten or typewritten, signed by the petitioner, under penalty of perjury. You must set forth
CONCISELY the answer to each question in the proper space on the form. Any false statement of a material fact may serve
as the basis for prosecution and conviction for perjury.
You must not attach separate pages to this petition except that ONE separate additional page is permitted in answering
Question No.9.
Upon receipt of a fee of $5.00 your petition will be filed if it is in proper order.
If you are seeking leave to proceed in forma pauperis (without paying the $5.00 filing fee and other court costs), then you
must also execute the declaration on the last page, setting forth information which establishes your inability to pay the fees
and costs of the proceedings or to give security therefor. If you wish to proceed in forma pauperis, 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 prison account exceeds $25.00, you must pay the filing fee as required by the
rule of the district court.
When the petition is completed, the original and 3 copies, must be mailed to the Clerk of the United States District Court for
the Central District of California, United States Courthouse, 312 North Spring Street, Los Angeles, California 90012,
ATTENTION: Intake/Docket Section.
Only one sentence, conviction or parole matter may be challenged in a single petition. If you challenge more than one, you
must do so by separate petitions.
PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN FEDERAL CUSTODY (28 U.S.C § 2241)
CV-27 (02/05)Page 2 of 7PLEASE COMPLETE THE FOLLOWING: (Check appropriate number)
This petition concerns:
1. G a conviction.
2. G a sentence.
3. G jail or prison conditions.
4. G prison discipline.
5. G a parole problem.
6. G other.
PETITION
1.Place of detention 2.Name and location of court which imposed sentence 3.The indictment number or numbers (if known) upon which, and the offense or offenses for which, sentence was
imposed:
a. b. c. 4.The date upon which sentence was imposed and the terms of the sentence:
a. b. c. 5.Check whether a finding of guilty was made:
a. G After a plea of guilty
b. G After a plea of not guilty
c. G After a plea of nolo contendere
6. If you were found guilty after a plea of not guilty, check whether that finding was made by:
a. G a jury
b. G a judge without a jury
7. Did you appeal from the judgment of conviction or the imposition of sentence? G Yes G No
8.If you did appeal, give the following information for each appeal:
CAUTION:If you are attacking a sentence imposed under a federal judgment, you must first file a direct appeal or
motion under 28 U.S.C. §2255 in the federal court which entered the judgment.
a.(1) Name of court (2) Result (3) Date of result (4) Citation or number of opinion
PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN FEDERAL CUSTODY (28 U.S.C § 2241)
CV-27 (02/05)Page 3 of 7(5)Grounds raised (list each):
(a)(b)(c)(d)b.(1)Name of court (2) Result (3)Date of result (4)Citation or number of opinion (5) Grounds raised (list each):
(a)(b)(c)(d)9.State CONCISELY every ground on which you claim that you are being held unlawfully. Summarize briefly the
facts supporting each ground. If necessary, attach a SINGLE page only behind this page.
CAUTION:If you fail to set forth all grounds in this petition, you may be barred from presenting additional
grounds at a later date. You must state facts, not conclusions in support of your grounds. A rule of
thumb to follow is - who did exactly what to violate your rights at what time and place.
a.Ground one: Supporting FACTS (tell your story BRIEFLY without citing cases or law): b.Ground two: Supporting FACTS (tell your story BRIEFLY without citing cases or law):
PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN FEDERAL CUSTODY (28 U.S.C § 2241)
CV-27 (02/05)Page 4 of 7c.Ground three: Supporting FACTS (tell your story BRIEFLY without citing cases or law): d. Ground four: Supporting FACTS (tell your story BRIEFLY without citing cases or law): 10.Have you filed previous petitions for habeas corpus, motions under Section 2255 of Title 28, United States Code, or
any other applications, petitions or motions with respect to this conviction? G Yes G No
11.If your answer to Question No. 10 was yes, give the following information:
a.(1)Name of Court (2)Nature of proceeding (3)Grounds raised (4)Result (5)Date of result (6)Citation or number of any written opinions or orders entered pursuant to each disposition.
PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN FEDERAL CUSTODY (28 U.S.C § 2241)
CV-27 (02/05)Page 5 of 7b.(1)Name of Court (2)Nature of proceeding (3)Grounds raised (4)Result (5)Date of result (6)Citation or number of any written opinions or orders entered pursuant to each disposition.12.If you did not file a motion under Section 2255 of Title 28, United States Code, or if you filed such a motion and it
was denied, state why your remedy by way of such motion is inadequate or ineffective to test the legality of your
detention: 13.Are you presently represented by counsel? G YesG No
If so, provide name, address and telephone number Case name and court 14.If you are seeking leave to proceed in forma pauperis, have you completed the declaration setting forth the required
information? G YesG No
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 (or certify, verify, or state) under penalty of perjury that the foregoing is true and correct.
Executed on DateSignature of Petitioner
PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN FEDERAL CUSTODY (28 U.S.C § 2241)
CV-27 (02/05)Page 6 of 7PetitionerRespondent(s)DECLARATION IN SUPPORT
OF REQUEST
TO PROCEED
IN FORMA PAUPERIS
I, , declare that I am the petitioner in the above entitled
case; that in support of my motion to proceed without being required to prepay fees, costs or give security therefor, I state
that because of my poverty I am unable to pay the costs of said proceeding or to give security therefor; that I believe I am
entitled to relief.
1.Are you presently employed? G Yes G No
a.If the answer is yes, state the amount of your salary or wages per month, and give the name and address of your
employer. b.If the answer is no, state the date of last employment and the amount of the salary and wages per month which
you received. 2.Have you received, within the past twelve months, any money from any of the following sources?
a.Business, profession or form of self-employment?G Yes G No
b.Rent payments, interest or dividends?G Yes G No
c.Pensions, annuities or life insurance payments?G Yes G No
d.Gifts or inheritances?G Yes G No
e.Any other sources?G Yes G No
If the answer to any of the above is yes, describe each source of money and state the amount received from each
during the past twelve months: 3.Do you own any cash, or do you have money in a checking or savings account? (Include any funds in prison
accounts)G Yes G No
If the answer is yes, state the total value of the items owned: 4. Do you own any real estate, stocks, bonds, notes, automobiles, or other valuable property? (Excluding ordinary
household furnishings and clothing) G Yes G No
If the answer is yes, describe the property and state its approximate value:
PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN FEDERAL CUSTODY (28 U.S.C § 2241)
CV-27 (02/05)Page 7 of 75.List the persons who are dependent upon you for support, state your relationship to those persons, and indicate how
much you contribute toward their support: I, declare (or certify, verify or state) under penalty of perjury that the foregoing is true and correct.
Executed on DateSignature of Petitioner
CERTIFICATE
I hereby certify that the Petitioner herein has the sum of $ on account to his credit
at the institution where
he is confined. I further certify that Petitioner likewise has the following securities to his credit according to the records of
said institution:DateAuthorized Officer of InstitutionTitle of Officer
PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN FEDERAL CUSTODY (28 U.S.C § 2241)
CV-27 (02/05)Page 1 of 7NAMEPRISON IDENTIFICATION/BOOKING NO.ADDRESS OR PLACE OF CONFINEMENTNote:If represented by an attorney, provide name, address & telephone
number. It is your responsibility to notify the Clerk of Court in
writing of any change of address.
UNITED STATES DISTRICT COURT
CENTRAL DISTRICT OF CALIFORNIAFULL NAME (Include name under which you were convicted)
Petitioner,v.NAME OF WARDEN, (or other authorized person having custody of
petitioner)
Respondent.CASE NUMBER:
CVTo be supplied by the Clerk of the United States District Court
CRCriminal case under which sentence was imposed.
PETITION FOR WRIT OF HABEAS CORPUS BY
A PERSON IN FEDERAL CUSTODY
(28 U.S.C § 2241)
INSTRUCTIONS - READ CAREFULLY
This petition shall be legibly handwritten or typewritten, signed by the petitioner, under penalty of perjury. You must set forth
CONCISELY the answer to each question in the proper space on the form. Any false statement of a material fact may serve
as the basis for prosecution and conviction for perjury.
You must not attach separate pages to this petition except that ONE separate additional page is permitted in answering
Question No.9.
Upon receipt of a fee of $5.00 your petition will be filed if it is in proper order.
If you are seeking leave to proceed in forma pauperis (without paying the $5.00 filing fee and other court costs), then you
must also execute the declaration on the last page, setting forth information which establishes your inability to pay the fees
and costs of the proceedings or to give security therefor. If you wish to proceed in forma pauperis, 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 prison account exceeds $25.00, you must pay the filing fee as required by the
rule of the district court.
When the petition is completed, the original and 3 copies, must be mailed to the Clerk of the United States District Court for
the Central District of California, United States Courthouse, 312 North Spring Street, Los Angeles, California 90012,
ATTENTION: Intake/Docket Section.
Only one sentence, conviction or parole matter may be challenged in a single petition. If you challenge more than one, you
must do so by separate petitions.
PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN FEDERAL CUSTODY (28 U.S.C § 2241)
CV-27 (02/05)Page 2 of 7PLEASE COMPLETE THE FOLLOWING: (Check appropriate number)
This petition concerns:
1. G a conviction.
2. G a sentence.
3. G jail or prison conditions.
4. G prison discipline.
5. G a parole problem.
6. G other.
PETITION
1.Place of detention 2.Name and location of court which imposed sentence 3.The indictment number or numbers (if known) upon which, and the offense or offenses for which, sentence was
imposed:
a. b. c. 4.The date upon which sentence was imposed and the terms of the sentence:
a. b. c. 5.Check whether a finding of guilty was made:
a. G After a plea of guilty
b. G After a plea of not guilty
c. G After a plea of nolo contendere
6. If you were found guilty after a plea of not guilty, check whether that finding was made by:
a. G a jury
b. G a judge without a jury
7. Did you appeal from the judgment of conviction or the imposition of sentence? G Yes G No
8.If you did appeal, give the following information for each appeal:
CAUTION:If you are attacking a sentence imposed under a federal judgment, you must first file a direct appeal or
motion under 28 U.S.C. §2255 in the federal court which entered the judgment.
a.(1) Name of court (2) Result (3) Date of result (4) Citation or number of opinion
PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN FEDERAL CUSTODY (28 U.S.C § 2241)
CV-27 (02/05)Page 3 of 7(5)Grounds raised (list each):
(a)(b)(c)(d)b.(1)Name of court (2) Result (3)Date of result (4)Citation or number of opinion (5) Grounds raised (list each):
(a)(b)(c)(d)9.State CONCISELY every ground on which you claim that you are being held unlawfully. Summarize briefly the
facts supporting each ground. If necessary, attach a SINGLE page only behind this page.
CAUTION:If you fail to set forth all grounds in this petition, you may be barred from presenting additional
grounds at a later date. You must state facts, not conclusions in support of your grounds. A rule of
thumb to follow is - who did exactly what to violate your rights at what time and place.
a.Ground one: Supporting FACTS (tell your story BRIEFLY without citing cases or law): b.Ground two: Supporting FACTS (tell your story BRIEFLY without citing cases or law):
PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN FEDERAL CUSTODY (28 U.S.C § 2241)
CV-27 (02/05)Page 4 of 7c.Ground three: Supporting FACTS (tell your story BRIEFLY without citing cases or law): d. Ground four: Supporting FACTS (tell your story BRIEFLY without citing cases or law): 10.Have you filed previous petitions for habeas corpus, motions under Section 2255 of Title 28, United States Code, or
any other applications, petitions or motions with respect to this conviction? G Yes G No
11.If your answer to Question No. 10 was yes, give the following information:
a.(1)Name of Court (2)Nature of proceeding (3)Grounds raised (4)Result (5)Date of result (6)Citation or number of any written opinions or orders entered pursuant to each disposition.
PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN FEDERAL CUSTODY (28 U.S.C § 2241)
CV-27 (02/05)Page 5 of 7b.(1)Name of Court (2)Nature of proceeding (3)Grounds raised (4)Result (5)Date of result (6)Citation or number of any written opinions or orders entered pursuant to each disposition.12.If you did not file a motion under Section 2255 of Title 28, United States Code, or if you filed such a motion and it
was denied, state why your remedy by way of such motion is inadequate or ineffective to test the legality of your
detention: 13.Are you presently represented by counsel? G YesG No
If so, provide name, address and telephone number Case name and court 14.If you are seeking leave to proceed in forma pauperis, have you completed the declaration setting forth the required
information? G YesG No
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 (or certify, verify, or state) under penalty of perjury that the foregoing is true and correct.
Executed on DateSignature of Petitioner
PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN FEDERAL CUSTODY (28 U.S.C § 2241)
CV-27 (02/05)Page 6 of 7PetitionerRespondent(s)DECLARATION IN SUPPORT
OF REQUEST
TO PROCEED
IN FORMA PAUPERIS
I, , declare that I am the petitioner in the above entitled
case; that in support of my motion to proceed without being required to prepay fees, costs or give security therefor, I state
that because of my poverty I am unable to pay the costs of said proceeding or to give security therefor; that I believe I am
entitled to relief.
1.Are you presently employed? G Yes G No
a.If the answer is yes, state the amount of your salary or wages per month, and give the name and address of your
employer. b.If the answer is no, state the date of last employment and the amount of the salary and wages per month which
you received. 2.Have you received, within the past twelve months, any money from any of the following sources?
a.Business, profession or form of self-employment?G Yes G No
b.Rent payments, interest or dividends?G Yes G No
c.Pensions, annuities or life insurance payments?G Yes G No
d.Gifts or inheritances?G Yes G No
e.Any other sources?G Yes G No
If the answer to any of the above is yes, describe each source of money and state the amount received from each
during the past twelve months: 3.Do you own any cash, or do you have money in a checking or savings account? (Include any funds in prison
accounts)G Yes G No
If the answer is yes, state the total value of the items owned: 4. Do you own any real estate, stocks, bonds, notes, automobiles, or other valuable property? (Excluding ordinary
household furnishings and clothing) G Yes G No
If the answer is yes, describe the property and state its approximate value:
PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN FEDERAL CUSTODY (28 U.S.C § 2241)
CV-27 (02/05)Page 7 of 75.List the persons who are dependent upon you for support, state your relationship to those persons, and indicate how
much you contribute toward their support: I, declare (or certify, verify or state) under penalty of perjury that the foregoing is true and correct.
Executed on DateSignature of Petitioner
CERTIFICATE
I hereby certify that the Petitioner herein has the sum of $ on account to his credit
at the institution where
he is confined. I further certify that Petitioner likewise has the following securities to his credit according to the records of
said institution:DateAuthorized Officer of InstitutionTitle of Officer
PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN FEDERAL CUSTODY (28 U.S.C § 2241)
CV-27 (02/05)Page 1 of 7NAMEPRISON IDENTIFICATION/BOOKING NO.ADDRESS OR PLACE OF CONFINEMENTNote:If represented by an attorney, provide name, address & telephone
number. It is your responsibility to notify the Clerk of Court in
writing of any change of address.
UNITED STATES DISTRICT COURT
CENTRAL DISTRICT OF CALIFORNIAFULL NAME (Include name under which you were convicted)
Petitioner,v.NAME OF WARDEN, (or other authorized person having custody of
petitioner)
Respondent.CASE NUMBER:
CVTo be supplied by the Clerk of the United States District Court
CRCriminal case under which sentence was imposed.
PETITION FOR WRIT OF HABEAS CORPUS BY
A PERSON IN FEDERAL CUSTODY
(28 U.S.C § 2241)
INSTRUCTIONS - READ CAREFULLY
This petition shall be legibly handwritten or typewritten, signed by the petitioner, under penalty of perjury. You must set forth
CONCISELY the answer to each question in the proper space on the form. Any false statement of a material fact may serve
as the basis for prosecution and conviction for perjury.
You must not attach separate pages to this petition except that ONE separate additional page is permitted in answering
Question No.9.
Upon receipt of a fee of $5.00 your petition will be filed if it is in proper order.
If you are seeking leave to proceed in forma pauperis (without paying the $5.00 filing fee and other court costs), then you
must also execute the declaration on the last page, setting forth information which establishes your inability to pay the fees
and costs of the proceedings or to give security therefor. If you wish to proceed in forma pauperis, 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 prison account exceeds $25.00, you must pay the filing fee as required by the
rule of the district court.
When the petition is completed, the original and 3 copies, must be mailed to the Clerk of the United States District Court for
the Central District of California, United States Courthouse, 312 North Spring Street, Los Angeles, California 90012,
ATTENTION: Intake/Docket Section.
Only one sentence, conviction or parole matter may be challenged in a single petition. If you challenge more than one, you
must do so by separate petitions.
PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN FEDERAL CUSTODY (28 U.S.C § 2241)
CV-27 (02/05)Page 2 of 7PLEASE COMPLETE THE FOLLOWING: (Check appropriate number)
This petition concerns:
1. G a conviction.
2. G a sentence.
3. G jail or prison conditions.
4. G prison discipline.
5. G a parole problem.
6. G other.
PETITION
1.Place of detention 2.Name and location of court which imposed sentence 3.The indictment number or numbers (if known) upon which, and the offense or offenses for which, sentence was
imposed:
a. b. c. 4.The date upon which sentence was imposed and the terms of the sentence:
a. b. c. 5.Check whether a finding of guilty was made:
a. G After a plea of guilty
b. G After a plea of not guilty
c. G After a plea of nolo contendere
6. If you were found guilty after a plea of not guilty, check whether that finding was made by:
a. G a jury
b. G a judge without a jury
7. Did you appeal from the judgment of conviction or the imposition of sentence? G Yes G No
8.If you did appeal, give the following information for each appeal:
CAUTION:If you are attacking a sentence imposed under a federal judgment, you must first file a direct appeal or
motion under 28 U.S.C. §2255 in the federal court which entered the judgment.
a.(1) Name of court (2) Result (3) Date of result (4) Citation or number of opinion
PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN FEDERAL CUSTODY (28 U.S.C § 2241)
CV-27 (02/05)Page 3 of 7(5)Grounds raised (list each):
(a)(b)(c)(d)b.(1)Name of court (2) Result (3)Date of result (4)Citation or number of opinion (5) Grounds raised (list each):
(a)(b)(c)(d)9.State CONCISELY every ground on which you claim that you are being held unlawfully. Summarize briefly the
facts supporting each ground. If necessary, attach a SINGLE page only behind this page.
CAUTION:If you fail to set forth all grounds in this petition, you may be barred from presenting additional
grounds at a later date. You must state facts, not conclusions in support of your grounds. A rule of
thumb to follow is - who did exactly what to violate your rights at what time and place.
a.Ground one: Supporting FACTS (tell your story BRIEFLY without citing cases or law): b.Ground two: Supporting FACTS (tell your story BRIEFLY without citing cases or law):
PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN FEDERAL CUSTODY (28 U.S.C § 2241)
CV-27 (02/05)Page 4 of 7c.Ground three: Supporting FACTS (tell your story BRIEFLY without citing cases or law): d. Ground four: Supporting FACTS (tell your story BRIEFLY without citing cases or law): 10.Have you filed previous petitions for habeas corpus, motions under Section 2255 of Title 28, United States Code, or
any other applications, petitions or motions with respect to this conviction? G Yes G No
11.If your answer to Question No. 10 was yes, give the following information:
a.(1)Name of Court (2)Nature of proceeding (3)Grounds raised (4)Result (5)Date of result (6)Citation or number of any written opinions or orders entered pursuant to each disposition.
PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN FEDERAL CUSTODY (28 U.S.C § 2241)
CV-27 (02/05)Page 5 of 7b.(1)Name of Court (2)Nature of proceeding (3)Grounds raised (4)Result (5)Date of result (6)Citation or number of any written opinions or orders entered pursuant to each disposition.12.If you did not file a motion under Section 2255 of Title 28, United States Code, or if you filed such a motion and it
was denied, state why your remedy by way of such motion is inadequate or ineffective to test the legality of your
detention: 13.Are you presently represented by counsel? G YesG No
If so, provide name, address and telephone number Case name and court 14.If you are seeking leave to proceed in forma pauperis, have you completed the declaration setting forth the required
information? G YesG No
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 (or certify, verify, or state) under penalty of perjury that the foregoing is true and correct.
Executed on DateSignature of Petitioner
PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN FEDERAL CUSTODY (28 U.S.C § 2241)
CV-27 (02/05)Page 6 of 7PetitionerRespondent(s)DECLARATION IN SUPPORT
OF REQUEST
TO PROCEED
IN FORMA PAUPERIS
I, , declare that I am the petitioner in the above entitled
case; that in support of my motion to proceed without being required to prepay fees, costs or give security therefor, I state
that because of my poverty I am unable to pay the costs of said proceeding or to give security therefor; that I believe I am
entitled to relief.
1.Are you presently employed? G Yes G No
a.If the answer is yes, state the amount of your salary or wages per month, and give the name and address of your
employer. b.If the answer is no, state the date of last employment and the amount of the salary and wages per month which
you received. 2.Have you received, within the past twelve months, any money from any of the following sources?
a.Business, profession or form of self-employment?G Yes G No
b.Rent payments, interest or dividends?G Yes G No
c.Pensions, annuities or life insurance payments?G Yes G No
d.Gifts or inheritances?G Yes G No
e.Any other sources?G Yes G No
If the answer to any of the above is yes, describe each source of money and state the amount received from each
during the past twelve months: 3.Do you own any cash, or do you have money in a checking or savings account? (Include any funds in prison
accounts)G Yes G No
If the answer is yes, state the total value of the items owned: 4. Do you own any real estate, stocks, bonds, notes, automobiles, or other valuable property? (Excluding ordinary
household furnishings and clothing) G Yes G No
If the answer is yes, describe the property and state its approximate value:
PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN FEDERAL CUSTODY (28 U.S.C § 2241)
CV-27 (02/05)Page 7 of 75.List the persons who are dependent upon you for support, state your relationship to those persons, and indicate how
much you contribute toward their support: I, declare (or certify, verify or state) under penalty of perjury that the foregoing is true and correct.
Executed on DateSignature of Petitioner
CERTIFICATE
I hereby certify that the Petitioner herein has the sum of $ on account to his credit
at the institution where
he is confined. I further certify that Petitioner likewise has the following securities to his credit according to the records of
said institution:DateAuthorized Officer of InstitutionTitle of Officer
