Fill and Sign the How to Get a Commutation Executive Clemency in California Form

Application for clemency 2/07 1 AP PL ICA TIO N FO R CLE M ENCY O ffic e o f t h e G overn or S ta te o f C alif o rn ia S ta te Ca pit o l S acra m en to , Ca lif o rn ia 9 581 4 T his A pplic atio n f o r C le m en cy m ust b e u se d t o r e q uest: · a c o m muta tio n ( re d uctio n) o f t h e a p plic an t's c u rre n t s e n te n ce i f t h e a p plic a n t i s p re se n tl y i n p ris o n o r j a il, o r o n p ro batio n o r p aro le ; · a p ard on b ase d u p on i n no cen ce; o r · a p ard on b ase d u p on r e h ab ilita tio n i f t h e a p plic an t h as c o m ple te d h is o r h er s e n te n ce b ut i s n o t e lig ib le f o r a C ertif ic a te o f R eh ab ilita tio n u nd er P en al C ode s e ctio n 4 852.0 1. P le ase c o m ple te s e c tio ns I , I II a n d I V an d t h at p ortio n o f s e ctio n I I t h at a p plie s t o y o ur c ase . Ple a se T YP E o r P RI NT i n b lu e o r b la ck i n k. I . A PPL IC A NT IN FO RM ATIO N To b e c om ple te d b y al l ap plic an ts L A ST Na me F IR ST Na me MIDDL E Na me Da te o f B ir th P la ce o f B ir th Socia l S ecu rit y N um ber Pris o n Nu mber C urren t R esid en ce A ddre ss A partm en t, L ot, S uite , S pace, e tc . C it y S ta te Zip c o de R eas on for R eq uestin g C le m en cy W hat r e lie f a re y o u r e q uesti n g? (C om ple te t h e c o rre sp ond in g p ortio n o f s e ctio n I I) o P ard on b ase d o n r e h ab ilita tio n a n d n o t e lig ib le f o r a C ertif ic ate o f R eh ab ilita tio n u nd er P en al C ode s e ctio n 4 852.0 1 o C om muta tio n o f c u rre n t s e n te n ce o P ard on b ase d u p on i n no cen ce o C om muta tio n/P ard on b ase d o n B atte re d W om an ’s S ynd ro m e o C om passio nate R ele ase o Ot her W hy a re y o u r e q uesti n g c le m en cy ? C on viction Infor mat ion Com mit m en t O ffe n se Da te o f o ffe n se Date o f c o nv ic tio n Arre sti n g a g en cy County o f c o nvic tio n S up erio r c o urt c ase n u m ber Your t r ia l a tto rn ey ’s n am e a n d a d dre ss S en te n ce I f y o u a re c u rre n tl y a p ris o ner, w hat i s y o ur r e le ase d ate , i f a n y? Di d y o u a p peal y o ur c ase ? o Ye s o No If y es, a p pella te c ase n u m ber a n d s ta tu s o f c a se Application for clemency 2/07 2 Prior Convictions: List all prior convictions, including any in other states or countries. Offense(s): Date of offense(s): County of conviction(s): Sentence(s): Current Attorney Information Are you currently represented by an attorney? o Yes o No If yes, please provide his or her name, address and telephone number. First and last name: Telephone number: Address: Information Required by Penal Code Section 4807.2 Have you paid or given any money, gift or consideration to anyone for assisting you with this application? o Yes o No If yes, please provide his or her name, address and telephone number. First and last name: Telephone number: Address: Application for clemency 2/07 3 II. REQUEST FOR CLEMENCY Please complete the section below that applies to your request. COMPASSIONATE RELEASE Complete this section if you are presently in prison and requesting clemency due to a medical condition. Please explain the medical condition that warrants clemency: Your current physician’s name: Physician’s address: Physician’s telephone number: Have you applied to the Department of Corrections and Rehabilitation or the Board of Parole Hearings for a recall of your sentence pursuant to Penal Code Sections 1170? o Yes o No What was the result? PARDON BASED ON REHABILITATION Complete this section if you have completed your sentence, you are requesting clemency based upon rehabilitation and you are not eligible for a Certificate of Rehabilitation under Penal Code section 4852.01. Give a brief account of your offense. Explain your rehabilitation efforts during incarceration. Describe your record in prison, jail, parole or probation. (List all disciplinary action taken against you) When were you discharged from probation or parole? Describe your rehabilitation and activities since release. Why you are requesting a pardon? Application for clemency 2/07 4 PARDON BASED ON INNOCENCE Complete this section if you are requesting a pardon based upon innocence. Describe the evidence of your innocence that was discovered after conviction and explain its importance. Has this new evidence been presented to the arresting agency or district attorney? If so, what was the result? Has this new evidence been presented to the courts? If so, what was the result? COMMUTATION/PARDON BASED ON BATTERED WOMAN'S SYNDROME Complete this section if you are requesting clemency based upon battered woman's syndrome. Describe the evidence of battering and its effects in the relationship between you and the victim that led to the crime. Was this evidence presented at trial? Have you sought a writ of habeas corpus pursuant to Penal Code section 1473.5 based upon this evidence? COMMUTATION OF SENTENCE Complete this section if you are currently under sentence and requesting clemency for any reason not covered above. Explain why you are requesting clemency. Have you sought relief from the courts? Application for clemency 2/07 5 III NOTICE TO DISTRICT ATTORNEY Penal Code section 4804 requires that you give the district attorney of the county of conviction written notice of your intention to apply for a pardon. You must complete the attached form and mail it to the district attorney before you submit this application to the Governor's Office. If you are requesting a pardon for more than one conviction involving more than one county, each district attorney must be given notice. I declare under penalty of perjury under the laws of the State of California that I have served the district attorney of the county of _________________________________ with notice of my intent to apply for a pardon, as required by Penal Code section 4804 . (Name of county) ______________________ __________ _______________ (Applicant's signature) (Date) IV DECLARATION UNDER PENALTY OF PERJURY This Application for Clemency may be submitted to the Board of Parole Hearings for investigation and recommendation pursuant to Penal Code Section 4812. This application may also be submitted to law enforcement or other agencies for investigation or recommendation. I certify (or declare) under penalty of perjury under the laws of the State of California that the forgoing is true and correct. I understand that any omission or misstatement of facts may result in denial of my application and the filing of perjury charges against me. __________________________________________ ________________ (Applicant’s signature) (Date signed) Notice of Intention 1/04 N OT IC E OF IN TEN TIO N T O APP L Y F OR C LEM EN CY This N otic e i s s ubm it te d p ursu an t t o P en al C od e s ection 4804 T o t h e Di str ic t A tto rn ey o f County : C oun ty o f C on vic tio n P le ase t a k e n o tic e t h at I , , w as F ull N am e – F ir s t, M id d le a n d L ast co nvic te d o f t h e c rim e o f , G iv e o ff e n se a n d P en al C od e s e c ti o n co m mitte d i n t h e C ounty o f , S ta te o f C ali f o rn ia , C oun ty o f C on vic tio n c o nvic te d o n an d s e n te n ced t o . D ate o f c o n vic ti o n Sen te n ce I w ill s u b m it a n a p plic atio n t o t h e Go vern o r o f t h e S ta te o f C alif o rn ia r e q uesti n g a o P ard o n b ase d u p on r e h ab ilita tio n o C om muta tio n o f c u rre n t s e n te n ce o P ard o n b ase d u p on i n no ce n ce o C om passio nate r e le ase o C om muta tio n/P ard on b ase d o n B atte re d W om an ’s S ynd ro m e o Ot her If o th er, B REIF L Y E X PL A IN Full N am e o f A ppli c an t – T Y PE D o r P R IN TE D Appli c an t’ s S ig n atu re Month , D ay , Y ea r Appli c an t’ s S tr e et A ddre ss A ppli c an t’ s C it y , S ta te , Z ip C od e T his S ection to b e C om ple te d B y D is tr ic t A ttor ney O nly St ate of Califor nia C ount y of ____________________________ } SS. I , D is tr ic t A ttor ne y of the Count y of of , St ate of Califor nia, do h ere by acknow le dge receipt of not ic e f rom t hat Name o f A pplic a n t he/s he int ends to appl y t o t he G overnor of the St ate of Califor nia f or a Tra di tional Par don. [Si gne d] Dis tr ic t A ttor ne y of the Count y of