Post Conviction Habeas Corpus Form Petition For Writ Of Habeas Corpus {Appendix A}

APPENDIX A POST-CONVICTION HABEAS CORPUS FORM PETITION FOR WRIT OF HABEAS CORPUS AD SUBJICIENDUM UNDER W. VA. CODE 53-4A-1 Instructions - Read Carefully1. This petition must be legibly handwritten or typewritten, and signed by the petitioner under penalty of perjury. Any false statement of a material fact may serve as the bas is for prosecution and conviction for perjury. All questions must be answered concisely in the proper space on the form. 2. Additional pages are not permitted except with respect to the facts which you rely upon to support your grounds for relief. No citation of authorities need be furnished. If brief s or arguments are submitted, they should be submitted in the form of a separate memorandum.3. 5.00 your petition will be filed if it is in proper order.8Upon receipt of a fee of $ 4. If you do not have the necessary funds for fees, transcripts, counsel, and other cost s connected with a petition of this type, you may request permission to proceed in forma pauperis, by executing the form attached as Appendix B, setting forth information establishing your inability to pay the costs. If you wish to proceed in forma pauperis, you must have an authorized officer at the penal institution complete the certifi cate as to the amount of money on deposit to your credit in any account in the institut ion. 5. Your attention is directed to the fact that you must include all grounds for relief and all facts supporting such grounds for relief in the petition you file seeking relief fro m any judgment of conviction. 6. When the petition is fully completed, the original and at least two copies may be mailed to (1) the clerk of the circuit court of the county where you are incarcerated; or (2) the c lerk of the circuit court of the county where you were convicted and sentenced. You may also file the petition with the Clerk of the Supreme Court of Appeals. You are advis ed, however, that the Supreme Court rarely grants relief on petitions originally filed there.7. Petitions which do not conform to these instructions will be returned with a notation as to the deficiency. <<<<<<<<<********>>>>>>>>>>>>> 2 PETITION UNDER W. VA. CODE 53-4A-1 FOR WRIT OF HABEAS CORPUS County STATE OF WEST VIRGINIA Name Prisoner No. Case No.Place of Confinement Name of Petitioner (include name under which convicted) Name of Respondent (authorized person having custody of petitioner) v. PETITION 1. Name and location of court which entered the judgment of conviction under attack _________________________________ _____________________________________________________________________________________________________2. Date of judgment of conviction ___________________________________________________________________________3. Length of sentence _____________________________________________________________________________________4. Nature of offense involved (all counts) _____________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________5. What was your plea? (Check one) (a) Not guilty (b) Guilty (c) Nolo contendere If you entered a guilty plea to one count or indictment, and a not guilty plea to another count or indictment, give details: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________6. If you pleaded not guilty, what kind of trial did you have? (Check one) (a) Jury (b) Judge Only 7. Did you testify at the trial? Yes No 8. Did you file a direct appeal from the judgment of conviction in the Supreme Court of Appeals? Yes No 2 <<<<<<<<<********>>>>>>>>>>>>> 39. If you did appeal, answer the following: (a) Date of filing ______________________________________________________________________________________ (b) Grounds raised ____________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ (c) Was the petition granted or refused ? (d) If refused, what was date of refusal? ___________________________________________________________________ (e) If granted, give date and type of result and citation, if known. ______________________________________________ __________________________________________________________________________________________________10. Other than a direct appeal from the judgment of conviction and sentence, have you previously filed any petitions, applications, or motions with respect to this judgment in any court, state or federal? Yes No 11. If your answer to 10 was yes, give the following information: (a) (1) Name of court ________________________________________________________________________________ (2) Nature of proceeding ___________________________________________________________________________ _____________________________________________________________________________________________ (3) Grounds raised ________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ (4) Did you receive an evidentiary hearing on your petition, application or motion? Yes No (5) Result _______________________________________________________________________________________ (6) Date of result _________________________________________________________________________________ (b) As to any second petition, application or motion give the same information: (1) Name of court ________________________________________________________________________________ (2) Nature of proceeding ___________________________________________________________________________ ____