Fill and Sign the Prison Number Form

CV-36 (12/88)REQUEST BY PRISONER UNDER CALIFORNIA DEATH JUDGMENT FOR APPOINTMENT OF COUNSEL PURSUANT TO 18 U.S.C. SECTION 3006AName: Prison Number: Place of Confinement: UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIA PETITIONER, v. RESPONDENT(S).CASE NUMBERREQUEST BY PRISONER UNDER CALIFORNIA DEATH JUDGMENT FOR APPOINTMENT OF COUNSEL PURSUANT TO 18 U.S.C. SECTION 3006A I, , request that the Court appoint an attorney to represent me in death penalty habeas corpus litigation to be initiated in the federal courts on my behalf. In support of this request, I hereby declare: 1.I was sentenced to death in the County Superior Court, State of California, on . I am incarcerated at Prison, located in, California. 2.My death sentence was affirmed by the California Supreme Court on . 3.I intend to file a petition for writ of habeas corpus in this Court, alleging federal constitutional errors which entitle me to relief from the judgment of death. I need the assistance of counsel in preparing and litigating the petition. 4.The attorney who represented me in the most recent state court proceedings related to my death sentence was . He/she has informed me that he/she is not available to represent me in federal habeas corpus proceedings. 5.I cannot afford to retain an attorney to represent me in these proceedings . I have the following assets [include any income, cash and property]: and the following debts: I declare under penalty of perjury that the above statements are true and correct.DateSignature of Petitioner