Fill and Sign the Petitioners Full Name Form

1 IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON DIVISION I )) ) NO._____________________________ ) ) PERSONAL RESTRAINT PETITION___________________________________ )Petitioner’s Full NameIf there is not enough room on this form, use the back of these pages or use other paper. Fill out all of the form and other papers you are attaching before you sign this form in front of a notary.A. STATUS OF PETITIONER I, _______________________________________________________________________ (Full name and current address)______________________________________________________________________________,Apply for relief from confinement. I am ____ am not _____ now in custody serving a sentence upon conviction of a crime. (If not serving a sentence upon conviction of a crime) I am now in custody because of the following type of court order: ___________________________________ (Identify type of court order)______________________________________________________________________________.1. The court in which I was sentenced is: ____________________________________________.2. I was convicted of the crime of: _________________________________________________.3. I was sentenced after (check one) Trial ____ Plea of Guilty ____ on ____________________. Date of Sentence4. The Judge who imposed sentence was ____________________________________________.5. My lawyer at trial court was ____________________________________________________, Name and Address if known______________________________________________________________________________. 26. I did ___ did not ____ appeal from the decision of the trial court. (If the answer is that I did), I appealed to: ___________________________________________________________________. Name of court or courts to which appeal took place7. My lawyer for my appeal was: __________________________________________________. Name and address if known or write “none”The decision of the appellate court was ______was not ______ published. (If the answer is that it was published, and I have this information) the decision is published in ___________________________________________________________________________________________________.8. Since my conviction I have ____have not _____asked a court for some relief from my sentence other than I have already written above. (If the answer is that I have asked, the court I asked was ______________________________________________. Relief was denied on Name of court ______________________________________________________________________.Date of Decision or, if more than one, all dates)(If you have answered in question 7 that you did ask for relief), the name of your lawyer in the proceedings mentioned in my answer was _________________________________________ Name and address if known____________________________________________________________________________.9. If the answers to the above questions do not really tell about the proceedings and the courts, judges and attorneys involved in your case, tell about it here: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________.B. GROUNDS FOR RELIEF:(If I claim more than one reason for relief from confinement, I will attach sheets for each reason separately, in the same way as the first one. The attached sheets should be numbered “First Ground”, “Second Ground”, “Third Ground”, etc). I claim that I have ______ reason(s) for this court to grant me relief from the conviction and sentence described in Part A. __________Ground (First, Second, etc) 31. I should be given a new trial or released from confinement because (State legal reasons why you think there was some error made in your case which gives you the right to a new trial or release from confinement): _________________________________________________________________________________________________________________________________________________________________________________________________________________.2. The following facts are important when considering my case. (After each fact statement put the name of the person or persona who know the fact and will support your statement of the fact. If the fact is already in the record of your case, indicate that also) ______________________________________________________________________________________________________________________________________________________________________________________.3. The following reported court decisions (indicate citations if possible) in cases similar to mine show the error I believed happened in my case. (If none are known, state “None Known”. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________.4. The following statutes and constitutional provisions should be considered by the court. (If none are now, state, “None Known”) ______________________________________________________________________________________________________________________________.5. This petition is the best way I know to get the relief I want, and not other way will work as well because: __________________________________________________________________.C. STATEMENT OF FINANCES: If you cannot afford to pay the $250 filing fee or cannot afford to pay an attorney to help you, fill out this form. If you have enough money for these, do not fill this part of the form. If currently in confinement you will need to attach a copy of your prison finance statement. 1. I do ____ do not_____ ask the court to file this without making me pay the $250 filing fee because I am so poor and cannot pay the fee. 2. I have $__________ in my prison or institution account. 43. I do ____ do not _____ ask the court to appoint a lawyer for me because I am so poor and cannot afford to pay a layer.4. I am ____ am not ____ employed. My salary or wages amount to $__________a month. My employer is __________________________________________________________________. Name and address of employer5. During the past 12 months I did _____ did not ______ get any money from a business, profession or other form of self-employment. (If I did, it was ________________________ Type of self-employmentAnd the total income I received was $___________________.6. During the past 12 months I:Did ___ Did Not ___ Receive any rent payments. If so, the total I received was $___________Did ___ Did Not ___ Receive any interest. If so, the total I received was $__________________Did ___ Did Not ___ Receive any dividends. If so, the total I received was $______________Did ___ Did Not ___ Receive any other money. If so the total I received was $______________Do___ Do Not ____ Have any cash except as said in question 2 of Statement of Finances. If so the total amount of cash I have is $________________.Do ___ Do Not ____ Have any savings or checking accounts. If so, the total amount in all accounts is $_____________Do ____Do Not____ Own stocks, bonds or notes. If so, their total value is: $______________. 7. List all real estate and other property or things of value which belong to you or in which you have an interest. Tell what eat item or property is worth and how much you owe on it. Do not list household furniture and furnishings and clothing which you or your family need. Items Value__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________8. I am ____ am not _____ married. If I am married, my wife or husband’s name and address is:____________________________________________________________________________________________________________________________________________________________. 59. All of the persons who need me to support them are listed below:Name & Address Relationship Age________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________10. All the bills I owe are listed here:Name & Address of Creditor Amount_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________D. REQUEST FOR RELIEF: I want this court to: ______ Vacate my conviction and give me a new trial______ Vacate my conviction and dismiss the criminal charges against me without a new trial______ Other: _______________________________________________________________ (Please Specify) ____________________________________________________________________ 6E. OATH OF PETITIONERSTATE OF WASHINGTON ) ) ss.COUNTY OF _____________) After being first duly sworn, on oath, I depose and say: That I am the petitioner, that I have read the petition, know its contents, and I believe the petition is true. _____________________________________________ (Signature Here) SUBSCRIBED AND SWORN to before me this _____day of ___________________ 200___ _____________________________________________ Notary Public in and for the State of WashingtonResiding at ___________________________________ If a notary is not available, explain why none is available and indicate who can be contacted to help you find a Notary: ______________________________________________________________________________________________________________________________________________________________________________________________________________. I declare that I have examined this petition and to the best of my knowledge and belief it is true and correct.DATED This ________ day of ______________________________, 200___. _____________________________________________ (Signature Here) 7