Georgia > Statewide > Superior Court > Inmate-Habeas Corpus
Inmate Form For Civil Action CA-1 - Georgia
| Inmate Form For Civil Action Form. This is a Georgia form and can be used in Inmate-Habeas Corpus Superior Court Statewide . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
INMATE FORM FOR CIVIL ACTION INSTRUCTIONS - READ CAREFULLY (NOTE: O.C.G.A.9-10-14(a) requires the proper use of this form, and failure to use this form will result in the clerk of any court refusing to accept the action for filing.)1. Any action filed by an inmate of a state or local panel or correctional institution against the state or a local government or against any agency or officer of a state or local government must be filed on the appropriate form or forms promulgated by the Administrative Office of the Courts.2. This application must be legibly handwritten or typewritten, and signed by the petitioner. Any false sta tement of a material fact may serve as the basis for prosecution for perjury. All questions must be answered concisely in the proper space on the form. 3. O.C.G.A.42-12-1 et. seq. provides that an inmates institutional account shall be subject to seizure for the filing of frivolous litigation.4. Any inmate may submit with the complaint or other initial pleading any additional matter in any form if the pleading includes the form or forms attached hereto. Materials attached to the forms should be legibly handwritten, typewritten or copied.5. Upon receipt of the appropriate filing fee or if permission to proceed in forma pauperis has been granted, your petition will be filed if it is in the proper order.6. If the inmate wishes to file an affidavit of indigency, it must be accompanied by a certification from the institution wherein the inmate is incarcerated that the financial statement correctly states the amount of funds in any and all custodial accounts held with the institution.7. Any Inmate Form for Civil Action which does not conform to these instructions will be returned with a notation as to the deficiency.8. These forms may be obtained from the Administrative Office of the Courts through the head of the institution in which the inmate is incarcerated.<<<<<<<<<********>>>>>>>>>>>>> 2 IN THE SUPERIOR COURT OF STATE OF GEORGIA , Plaintiff , Civil Action No. Inmate Number vs. Nature of Action: , , , Defendant(s) INMATE FORM FOR CIVIL ACTION PART I : BACKGROUND 1. Name and location of prison in which you are now confined : 2. Sentence you are now serving : Name and location of court which imposed sentence : Approximate date your sentence will be completed : 3. The indictment number or numbers (if known) upon which, and the offense or offenses for which sentence was imposed : a. b. c. 4. Give the approximate date upon which sentence was imposed and the terms of the sentence: a. b. c. Administrative Office of the Courts (Revised 02-15-00) Form CA-1<<<<<<<<<********>>>>>>>>>>>>> 3 5. Check whether a finding of guilty was made after a plea of : G Guilty G Guilty but mentally ill G Nolo Contendere G Not Guilty 6. If you were found guilty after a plea of not guilty, check whether that finding was made by : G A Jury G A Judge without a Jury 7. Did you appeal from the judgment of conviction or the imposition of sentence? G Yes G No If your answer is Yes, complete the following : a. The name of each court to which you appealed : 1. 2. 3. b. The result in each such court to which you appealed : 1. 2. 3. c. The approximate date of each such result : 1. 2. 3. d. If known, citations of any written opinion or orders entered pursuant to such results : 1. 2. 3. PART II: OTHER LAWSUITS 8. OTHER THAN LAWSUITS ALREADY LISTED in questions 3 through 7, have you ever begun or are you now beginning other lawsuits in federal or state courts dealing with the same facts involved in this action or relating to your imprisonment? G Yes G No 9. If your answer to number 8 is Yes, describe the lawsuit in the space below. (If there is more than one lawsuit, describe the additional lawsuits on another piece of paper, using the same outline for each lawsuit.) a. Parties to the previous lawsuit : Plaintiffs : Defendants : b. Court (If federal court, name the district. If state court, name the court and county) : c. Docket Number : Administrative Office of the Courts (Revised 02-15-00)2 Form CA-1<<<<<<<<<********>>>>>>>>>>>>> 4 d. Name of judge to whom the case was assigned : e. Date on which you filed lawsuit : f. Date of disposition, if any, of lawsuit : g. What was the lawsuit about? h. What was the outcome of the lawsuit? (For example, was the case dismissed? Was it appealed? Is it still pending?) i. Citations, if known, to any written opinions or orders in the lawsuit : PART III: GRIEVANCE PROCEDURES 10. Is there a prisoner grievance procedure at the institution in which you are presently confined? G Yes G No 11. If your answer to number 10 is Yes, answer the following : a. Did you present the facts relating to your complaint in the institutions prisoner grievance procedures? G Yes G No b. If your answer to (a) above is Yes, What steps did you take? What was the result? c. If your answer to (a) above is No, explain why not : 12. Tell what you have done, other than what you have described in question 11, to bring your complaints to the attention of prison officials. In so doing, give dates, places, and names of persons talked to. Administrative Office of the Courts (Revised 02-15-00)3 Form CA-1<<<<<<<<<********>>>>>>>>>>>>> 5 Administrative Office of the Courts (Revised 02-15-00)4 Form CA-1<<<<<<<<<********>>>>>>>>>>>>> 613. Names, approximate dates of entry and exit, and locations of all prisons and jails in which you have been incarcerated : 14. As to your present confinement, state : Which part of the penitentiary or jail you are held in : How long have you been in this part of the penitentiary or jail? The full name of every prisoner now confined in the same general area : PART IV: STATEMENT OF CLAIMS 15. List the name and address of each plaintiff in this lawsuit : 16. List below for each defendant, the defendants full name, official position, and place of employment. Attach additional paper if necessary. Full Name Official Position Place of Employment STATEMENT OF CLAIM 17. Describe each and every FACT - not your opinions or views but what actually happened - supporting and explaining the basis for the lawsuit you have filed. DESCRIBE HOW EACH DEFENDANT IS INVOLVED. Include also the names of other persons involved, dates and places. If you intend to allege a number of related claims, you should number and set forth each claim separately. DO NOT GIVE ANY LEGAL ARGUMENT OR CITE ANY CASES OR STATUTES. (You may attach additional sheets of paper if necessary.) Administrative Office
|
|||||||
