Petition For Post-Conviction Relief

IN THE ___________ COURT OF __________ COUNTY STATE OF INDIANA __________________________ Full Name of Movant __________________________ Prison Number (if any) v. State of Indiana, Respondent. Case No. ____________________________ (To be supplied by the clerk of the court) INSTRUCTIONS - READ CAREFULLY In order for this motion to receive consideration by the court, it shall be in writing (legibly handwritten or typewritten), signed by the petitioner and verified before a person authorized to administer oaths, and it shall set forth in concise form the answers to each applicable question. If necessary, petitioner may furnish his answer to a particular question on the reverse side of the page or an additional blank page. Petitioner shall make it clear to which question any such continued answer refers. This motion must be filed in the court which imposed sentence. Under the provisions of Rule PC 1, petitioner is required to include in this motion every ground known to him for vacating, setting aside or correcting his conviction and sentence. Be sure to include every ground. Since every motion must be sworn to under oath, any false statement of a material fact therein may serve as the basis of prosecution and conviction for perjury. Petitioners should therefore exercise care to assure that all answers are true and correct. If the motion is taken in forma pauperis, it shall include an affidavit (attached at the back of the form) setting forth information which establishes that petitioner will be unable to pay costs of the proceedings. When the motion is completed, the original and two copies shall be mailed to the clerk of the court from which he was sentenced. 1. Place of detention, if detained ____________________________________________________ ____________________________________________________ If not, present address ____________________________________________________ ____________________________________________________ 2. Name and location of court which, and name of judge who, imposed sentence ____________________________________________________ ____________________________________________________ 3. The case number and the offense or offenses for which sentence was imposed ____________________________________________________ ____________________________________________________ 4. The date upon which sentence was imposed and the terms of the sentence ____________________________________________________ ____________________________________________________ 5. Was the finding of guilty made: ( ) After a plea of guilty? OR ( ) After a plea of not guilty? 6. Did you appeal from the judgment of conviction? ( ) Yes ( ) No 7. If you answered "yes" to (6), list: (a) The name of the court to which you appealed: ___________________________________________________ ___________________________________________________ (b) The result in such court and the date of such result: ___________________________________________________ ___________________________________________________ 8. State concisely all the grounds known to you for vacating, setting aside or correcting your conviction and sentence. (See Rule PC 1, Sec. 1a) ________________________________________________ ________________________________________________ ________________________________________________ (b) ________________________________________________ ________________________________________________ ________________________________________________ (c) ________________________________________________ ________________________________________________ ________________________________________________ (a) (If you have more grounds, use reverse side or separate sheet. However, if this is a successive petition for post-conviction relief, you may submit no more than fifteen (15) additional pages, double-spaced, to provide supporting facts. You may also submit exhibits.) 9. State concisely and in the same order the facts which support each of the grounds set forth in (8). ________________________________________________ ________________________________________________ ________________________________________________ (b) ________________________________________________ ________________________________________________ ________________________________________________ (c) ________________________________________________ ________________________________________________ ________________________________________________ (a) 10. Prior to this petition, have you filed with respect to this conviction: (a) Any petition for post conviction relief pursuant to Rule PC 1 or PC 2? ( ) Yes ( ) No (b) Any petitions for habeas corpus in state or federal courts? ( ) Yes ( ) No (c) Any petitions in the United States Supreme Court for certiorari? ( ) Yes ( ) No (d) Any other petitions, motions or applications in this or any other court? ( ) Yes ( ) No 11. If you answered "yes" to any part of (10), list with respect to each petition, motion or application: (a) Its specific nature: i. __________________________________________________________________________ ii. __________________________________________________________________________ iii. __________________________________________________________________________ (b) The name and location of the court in which each was filed: i. __________________________________________________________________________ ii. __________________________________________________________________________ iii. __________________________________________________________________________ (c) The disposition of the petition, motion or 16 application and the date of disposition: i. __________________________________________________________________________ ii. __________________________________________________________________________ iii. __________________________________________________________________________ (d) If known, citations of any written opinions or orders entered pursuant to each disposition: i. __________________________________________________________________________ ii. __________________________________________________________________________ iii. __________________________________________________________________________ 12. Has any ground set forth in (8) been previously presented to this or any other court, state or federal, in any petition, motion or application which you have filed? ( ) Yes ( ) No 13. If you answered "yes" to (12), identify: (a) Which grounds have been previously presented: i. ____________________