Fill and Sign the Family Guide Nys Department of Corrections and Form

PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN STATE CUSTODY (28 U.S\ .C § 2254) CV-69 (04/05) Page 1 of 10NAME PRISON IDENTIFICATION/BOOKING NO. ADDRESS OR PLACE OF CONFINEMENT Note: It is your responsibility to notify the Clerk of Court in writing of any\ change of address. If represented by an attorney, provide his name, address, telephone and facsimile numbers, and e-mail address. UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIA FULL NAME ( Include name under which you were convicted ) Petitioner, CASE NUMBER: CV To be supplied by the Clerk of the United States District Court v. NAME OF WARDEN, SUPERINTENDENT, JAILOR OR AUTHORIZED PERSON HAVING CUSTODY OF PETITIONER Respondent.G __________________ AMENDED PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN STATE CUSTODY 28 U.S.C. § 2254 PLACE/COUNTY OF CONVICTION PREVIOUSLY FILED, RELATED CASES IN THIS DISTRICT COURT ( List by case number ) CV CV INSTRUCTIONS - PLEASE READ CAREFULLY 1. To use this form, you must be a person who either is currently serving a sentence under a judgment against you in a California state court, or will be serving a sentence in the future under a judgment against you in a California state court. You ar\ e asking for relief from the conviction and/or the sentence. This form is your petition for\ relief. 2.In this petition, you may challenge the judgment entered by only one California state court. If you want to challenge the judgment entered by a different California state court, you must file a separate \ petition. 3.Make sure the form is typed or neatly handwritten. You must tell the truth and sign the form. If you make a false statement of a material fact, you may be prosecuted for perjury. 4.Answer all the questions. You do not need to cite case law, but you do need to state the federal\ legal theory and operative facts in support of each ground. You may submit additional pages if necessary\ . If you do not fill out the form properly, you will be asked to submit additional or correct information. If you want to submit a legal\ brief or arguments, you may attach a separate memorandum. 5.You must include in this petition all the grounds for relief from the conviction and/or sentence that you challenge. And you must state the facts that support each ground. If you fail to set forth all the grounds in this petition, you may be \ barred from presenting additional grounds at a later date. 6. You must pay a fee of $5.00. If the fee is paid, your petition will be filed. If you cannot afford\ the fee, you may ask to proceed in forma pauperis (as a poor person). To do that, you must fill out and sign the declaration of the\ last two pages of the form. Also, 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 at the institution. If your prison account exceed\ s $25.00, you must pay the filing fee. 7. When you have completed the form, send the original and two copies to th\ e following address: Clerk of the United States District Court for the Central District of Ca\ lifornia United States Courthouse ATTN: Intake/Docket Section 312 North Spring Street Los Angeles, California 90012 PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN STATE CUSTODY (28 U.S\ .C § 2254) CV-69 (04/05) Page 2 of 10PLEASE COMPLETE THE FOLLOWING: ( Check appropriate number) This petition concerns: 1. G a conviction and/or sentence. 2. G prison discipline. 3. G a parole problem. 4. G other. PETITION 1. Venue a.Place of detention b. Place of conviction and sentence 2. Conviction on which the petition is based (a separate petition must be filed for each conviction being attacked)\ . a. Nature of offenses involved (include all counts): b. Penal or other code section or sections: c. Case number: d. Date of conviction: e. Date of sentence: f. Length of sentence on each count: g. Plea (check one) : G Not guilty G Guilty G Nolo contendere h. Kind of trial (check one): G Jury G Judge only 3. Did you appeal to the California Court of Appeal from the judgment of co\ nviction? G Yes G No If so, give the following information for your appeal (and attach a copy of the Court of Appeal decision if available): a. Case number: b. Grounds raised (list each): (1) PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN STATE CUSTODY (28 U.S\ .C § 2254) CV-69 (04/05) Page 3 of 10(2) (3) (4) (5) (6) c. Date of decision: d. Result 4. If you did appeal, did you also file a Petition for Review with the California Supreme Court of the Court of Appeal decision? G Yes G No If so give the following information (and attach copies of the Petition for Review and the Supreme Court rul\ ing if available) : a. Case number: b. Grounds raised (list each): (1) (2) (3) (4) (5) (6) c. Date of decision: d. Result 5. If you did not appeal: a.State your reasons b. Did you seek permission to file a late appeal? G Yes G No 6. Have you previously filed any habeas petitions in any state court with r\ espect to this judgment of conviction? G Yes G No If so, give the following information for each such petition (use additional pages if necessary, and attach copies of the petitions and the rulings on the petitions if available) : PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN STATE CUSTODY (28 U.S\ .C § 2254) CV-69 (04/05) Page 4 of 10a. (1) Name of court: (2) Case number: (3) Date filed (or if mailed, the date the petition was turned over to the prison auth\ orities for mailing) : (4) Grounds raised (list each): (a) (b) (c) (d) (e) (f) (5) Date of decision: (6) Result (7) Was an evidentiary hearing held? G Yes G No b. (1) Name of court: (2) Case number: (3) Date filed (or if mailed, the date the petition was turned over to the prison auth\ orities for mailing) : (4) Grounds raised (list each): (a) (b) (c) (d) (e) (f) (5) Date of decision: (6) Result (7) Was an evidentiary hearing held? G Yes G No c. (1) Name of court: (2) Case number: (3) Date filed (or if mailed, the date the petition was turned over to the prison auth\ orities for mailing) : (4) Grounds raised (list each): (a) (b) PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN STATE CUSTODY (28 U.S\ .C § 2254) CV-69 (04/05) Page 5 of 10(c) (d) (e) (f) (5) Date of decision: (6) Result (7) Was an evidentiary hearing held? G Yes G No 7. For this petition, state every ground on which you claim that you are be\ ing held in violation of the Constitution, laws, or treaties of the United States. Attach additional pages if you \ have more than five grounds. Summarize briefly the facts supporting each ground. For example, if you are claiming ineffective a\ ssistance of counsel, you must state facts specifically setting forth what your attorney did or fa\ iled to do. CAUTION :Exhaustion Requirement : In order to proceed in federal court, you must ordinarily first exhau\ st your state court remedies with respect to each ground on which you are r\ equesting relief from the federal court. This means that, prior to seeking relief from the federa\ l court, you first must present all of your grounds to the California Supreme Court. a. Ground one: (1) Supporting FACTS: (2) Did you raise this claim on direct appeal to the California Court \ of Appeal? G Yes G No (3) Did you raise this claim in a Petition for Review to the Californi\ a Supreme Court? G Yes G No (4) Did you raise this claim in a habeas petition to the California Su\ preme Court? G Yes G No b. Ground two: (1) Supporting FACTS: (2) Did you raise this claim on direct appeal to the California Court \ of Appeal? G Yes G No (3) Did you raise this claim in a Petition for Review to the Californi\ a Supreme Court? G Yes G No PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN STATE CUSTODY (28 U.S\ .C § 2254) CV-69 (04/05) Page 6 of 10(4) Did you raise this claim in a habeas petition to the California Su\ preme Court? G Yes G No c. Ground three: (1) Supporting FACTS: (2) Did you raise this claim on direct appeal to the California Court \ of Appeal? G Yes G No (3) Did you raise this claim in a Petition for Review to the Californi\ a Supreme Court? G Yes G No (4) Did you raise this claim in a habeas petition to the California Su\ preme Court? G Yes G No d. Ground four: (1) Supporting FACTS: (2) Did you raise this claim on direct appeal to the California Court \ of Appeal? G Yes G No (3) Did you raise this claim in a Petition for Review to the Californi\ a Supreme Court? G Yes G No (4) Did you raise this claim in a habeas petition to the California Su\ preme Court? G Yes G No e. Ground five: (1) Supporting FACTS: (2) Did you raise this claim on direct appeal to the California Court \ of Appeal? G Yes G No (3) Did you raise this claim in a Petition for Review to the Californi\ a Supreme Court? G Yes G No (4) Did you raise this claim in a habeas petition to the California Su\ preme Court? G Yes G No PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN STATE CUSTODY (28 U.S\ .C § 2254) CV-69 (04/05) Page 7 of 108. If any of the grounds listed in paragraph 7 were not previously presente\ d to the California Supreme Court, state briefly which grounds were not presented, and give your reasons: 9. Have you previously filed any habeas petitions in any federal court with\ respect to this judgment of conviction? G Yes G No If so, give the following information for each such petition (use additional pages if necessary, and attach copies of the petitions \ and the rulings on the petitions if available) : a. (1) Name of court: (2) Case number: (3) Date filed (or if mailed, the date the petition was turned over to the prison auth\ orities for mailing) : (4) Grounds raised (list each): (a) (b) (c) (d) (e) (f) (5) Date of decision: (6) Result (7) Was an evidentiary hearing held? G Yes G No b. (1) Name of court: (2) Case number: (3) Date filed (or if mailed, the date the petition was turned over to the prison auth\ orities for mailing) : (4) Grounds raised (list each): (a) (b) (c) (d) (e) (f) (5) Date of decision: (6) Result PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN STATE CUSTODY (28 U.S\ .C § 2254) CV-69 (04/05) Page 8 of 10(7) Was an evidentiary hearing held? G Yes G No 10. Do you have any petitions now pending (i.e., filed but not yet decided)\ in any state or federal court with respect to this judgment of conviction? G Yes G No If so, give the following information (and attach a copy of the petition if available): (1) Name of court: (2) Case number: (3) Date filed (or if mailed, the date the petition was turned over to the prison auth\ orities for mailing) : (4) Grounds raised (list each): (a) (b) (c) (d) (e) (f) 11. Are you presently represented by counsel? G Yes G No If so, provide name, address and telephone number: WHEREFORE, petitioner prays that the Court grant petitioner relief to wh\ ich 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 Date Signature of Petitioner PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN STATE CUSTODY (28 U.S\ .C § 2254) CV-69 (04/05) Page 9 of 10Petitioner Respondent(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 accou\ nt? (Include any funds in prison accounts) G Yes G No If the answer is yes, state the total value of the items owned: PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN STATE CUSTODY (28 U.S\ .C § 2254) CV-69 (04/05) Page 10 of 104. 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 va\ lue: 5. List the persons who are dependent upon you for support, state your rela\ tionship 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 Date Signature of Petitioner CERTIFICATE I hereby certify that the Petitioner herein has the sum of $ on acco unt 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: Date Authorized Officer of Institution/Title of Officer