NamePrison NumberPlace of ConfinementIN THE UNITED STATES DISTRICT COURTFOR THE DISTRICT OF ARIZONA, )Full Name)))Petitioner,))Case Number (To be supplied byvs.)by the Clerk, U.S. District )Court), )(Name of Warden, Superintendent, ) Jailor, or authorized person)PETITION FOR WRIT OF HABEAShaving custody of petitioner.))CORPUS BY A PERSON IN FEDERAL )CUSTODY (28 U.S.C. § 2241) )are challenging a state or(Do not use this form if you )Respondent.)federal judgment or conviction )and sentence) )PETITION.2241(Revised9/1/91)530 12001 © American LegalNet, Inc.INSTRUCTIONS -READ CAREFULLY(1)This petition must be legibly handwritten or typewritten andsignedbythepetitionerunderpenaltyofperjury.Anyfalsestatement of a material fact may serve as the basis for prosecution and conviction for perjury. All questions must be answered concisely in the proper space on the form. Where more room is needed to answer any question, attach additional pages.(2)Additional pages are not permitted except with respect to thefactswhich you rely upon to support your grounds for relief. Nocitation of authorities need be furnished. If briefs or arguments are submitted, they should be submitted in the form of a separate memorandum.(3)Upon receipt of a fee of $5.00, your petition will be filed ifit is in proper order.(4)If you do not have the necessary filing fee, you may requestpermission to proceed in forma pauperis, in which event you must execute the Declaration on the last two (2) pages, setting forth information establishing your inability to prepay the fees and costs or 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 at the institution. If your prison account exceeds $25.00 you must pay the filing fee as required by the Rules of the District Court.(5)Onlyoneunlawfulconfinement,paroleorloss,credittimematter,etc.,maybechallengedinyouIfpetition.singleachallenge more than one, you should do so by separate petitions.(6)Your attention is directed to the fact that you must include allgrounds for relief and all facts supporting such grounds for relief in the petition.(7)When the petition is fully completed, the original and two (2)copies must be mailed to:Phoenix & Prescott Divisions:ORTucson Division:U.S. District Court ClerkU.S. District Court ClerkU.S. Courthouse, Suite 321U.S. Courthouse, Suite 1500401 West Washington Street, SPC 10405 West Congress StreetPhoenix, Arizona 85003-2119Tucson, Arizona 85701-5010(8)Petitions that do not conform to these instructions will bereturned with a notation as to the deficiency.22001 © American LegalNet, Inc.PETITION1.Nameandlocationofcourtthatenteredthejudgmentofconviction:2.Date of judgment of conviction: Case Number:3.Length of sentence:Sentencing Judge:4.Nature of offence(s) of which you were convicted:5.Did you appeal from the judgment of conviction? Yes( ) No( )6.Ifyoudidappeal,givethefollowinginformationforeachappeal:a.(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)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)7.State concisely every ground on which you claim that you are being held unlawfully. Summarize briefly the facts supporting eachground.statingpagesattachmayyounecessary,Ifadditional grounds and facts supporting same.CAUTION: In order to proceed in the federal court you must ordinarily first exhaust your administrative remedies as to each ground on which you request action by the federal court. As to all grounds on which you have previously exhausted administrative remedies, you should set them forth in this petition if you wish to seek federal relief. If you fail to set forth all such grounds in this petition, you may be barred from presenting them at a later date.32001 © American LegalNet, Inc.Foryourinformation,thefollowingisalistofthemostfrequently raised grounds for relief in habeas corpus proceedings. Each statement preceded by a letter constitutes a separate ground for possible relief. You may raise any grounds that you may have other thanthoselistedifyouhaveexhaustedallyouradministrativeremedies with respect to them. However, you should raise in this petition all available grounds.If you select one or more of these grounds for relief, you must allege facts in support of the ground or grounds that you choose. Do not check any of the grounds listed below. The petition will be returned to you if you merely check (a) through (m), or any one of these grounds:(a)Conditions of confinement violate a constitutional right.(b)Prison regulations, on their face or as enforced, are violative of the Constitution or other federal law.(c)Prison transfer has been threatened, carried out, or denied in violation of federal constitutional or statutory law.(d)Confinement is at a place forbidden by statutory law.(e)Convicted person's prisoner classification violates federal constitutional or other law.(f)Good time credit has been ended or forfeited in violation of federal constitutional or statutory law.(g)Creditfortimespentinorsentencingtopriorjailpendingappealhasbeenfederalofviolationindeniedconstitutional or other law.(h)Prisonofficialshaveconvictedthereleasetorefusedperson,eventhoughisorsentencehisservedhasheentitled to mandatory release.(i)Parolewasdenied,inrevokedorrescinded,postponed,violation of federal constitutional or other law.(j)Aparoleinexecutedorissuedwaswarrantviolationviolation of federal constitutional or other law.(k)There has been an unlawful refusal to terminate parole.(l)Convicted person is suffering adverse effects from a federal or state detainer lodged against him in violation of federal constitutional or other law.Custody is otherwise subject to collateral attack by reason of the conduct of prison or parole authorities.(m)42001 © American LegalNet, Inc.A.Ground One:Supporting FACTS (tell your story briefly without citing cases or law):A-1. Did you exhaust all administrative remedies relating to GroundOne?Yes ( ) No ( )A-2. This issue was presented:() To the Parole Commission () To the Office of General Counsel () OtherA-3. If the answer to A-1 is "no," explain why the issue was notraised.B.Ground Two:Supporting FACTS (tell your story briefly without citing cases or law):52001 © American LegalNet, Inc.B-1. Did y
|
Get this form for FREE as a print-only pdf
