Page 1 Motion to Vacate, Set Aside, or Correct a Sentence By a Person in Federal Custody (Motion Under 28 U.S.C. 2255) Instructions 1. To use this form, you must be a person who is serving a sentence under a judgment against you in a federal court. You are asking for relief from the conviction or the sentence. This form is your motion for relief.2. You must file the form in the United States district court that entered the judgment that you are challenging. If you want to challenge a federal judgment that imposed a sentence to be served in the future, you should file the motion in the federal court that entered that judgment. 3. Make sure the form is typed or neatly written. 4. You must tell the truth and sign the form. If you make a false statement of a material fact, you may be prosecuted for perjury. 5. Answer all the questions. You do not need to cite law. You may submit additional pages if necessary. If you do not fill out the form properly, you will be asked to submit additional or correct information. If you want to submit a brief or arguments, you must submit them in a separate memorandum. 6. If you cannot pay for the costs of this motion (such as costs for an attorney or transcripts), you may ask to proceed in forma pauperi (ass a poor person). To do that, you must fill out the last page of this form. Also, you must submit a certificate signed by an officer at the institution where you are confined showing the amount of money that the institution is holding for you. 7. In this motion, you may challenge the judgment entered by only one court. If you want to challenge a judgment entered by a different judge or division (either in the same district or in a different district), you must file a separate motion. 8. When you have completed the form, send the original and two copies to the Clerk of the United States District Court at this address: Clerk, United States District Court fothe Middle District of Pennsylvaniar P.O. Box 1148 Scranton, PA 18501-1148 9. CAUTION: You must include in this motion al tl he grounds for relief from the conviction or sentence that you challenge. And you must state the facts that support each ground. If you fail to set forth all the grounds in this motion, you may be barred from presenting additional grounds at a later date. 10. CAPITAL CASES: If you are under a sentence of death, you are entitled to the assistance of counsel and should request the appointment of counsel. >>>> 2 Page 2 MOTION UNDER 28 U.S.C. 2255 TO VACATE, SET ASIDE, OR CORRECT SENTENCE BY A PERSON IN FEDERAL CUSTODY District United States District Court Name (under which you were convicted): Docket or Case No.: Place of Confinement: Prisoner No.: UNITED STATES OF AMER ICA Movant (include name under which convicted) v. MOTION 1. (a) Name and location of court that entered the judgment of conviction you are challenging: (b) Criminal docket or case number (if you know): 2. (a) Date of the judgment of conviction (if you know): (b) Date of sentencing: 3. Length of sentence: 4. Nature of crime (all counts): 5. (a) What was your plea? (Check one) (1) Not guilty (2) Guilty (3) Nolo contendere (no contest) (b) If you entered a guilty plea to one count or indictment, and a not guilty plea to another count or indictment, what did you plead guilty to and what did you plead not guilty to? 6. If you went to trial, what kind of trial did you have? (Check one) Jury Judge only 7. Did you testify at a pretrial hearing, trial, or post-trial hearing? Yes No >>>> 3 Page 38. Did you appeal from the judgment of conviction? Yes No 9. If you did appeal, answer the following: (a) Name of court: (b) Docket or case number (if you know): (c) Result: (d) Date of result (if you know): (e) Citation to the case (if you know): (f) Grounds raised: (g) Did you file a petition for certiorari in the United States Supreme Court? Yes No If Yes, answer the following: (1) Docket or case number (if you know): (2) Result: (3) Date of result (if you know): (4) Citation to the case (if you know): (5) Grounds raised: 10. Other than the direct appeals listed above, have you previously filed any other motions, petitions, or applications concerning this judgment of conviction in any court? Yes No 11. If your answer to Question 10 was Yes, give the following information: (a) (1) Name of court: (2) Docket or case number (if you know): (3) Date of filing (if you know): (4) Nature of the proceeding: (5) Grounds raised: >>>> 4 Page 4 (6) Did you receive a hearing where evidence was given on your motion, petition, or application? Yes No (7) Result: (8) Date of result (if you know): (b) If you filed any second motion, petition, or application, give the same information: (1) Name of court: (2) Docket or case number (if you know): (3) Date of filing (if you know): (4) Nature of the proceeding: (5) Grounds raised: (6) Did you receive a hearing where evidence was given on your motion, petition, or application? Yes No (7) Result: (8) Date of result (if you know): (c) Did you appeal to a federal appellate court having jurisdiction over the action taken on your motion, petition,or application? (1) First petition: Yes No (2) Second petition: Yes No (d) If you did not appeal from the action on any motion, petition, or application, explain briefly why you did not:>>>> 5 Page 512. For this motion, state every ground on which you claim that you are being held in violation of the Constitution, laws, or treaties of the United States. Attach additional pages if you have more than four grounds. State the facts supporting each ground. GROUND ONE: (a) Supporting facts (Do not argue or cite law. Just state the specific facts that support your claim.): (b) Direct Appeal of Ground One: (1) If you appealed from the judgment of conviction, did you raise this issue? Yes No (2) If you did not raise this issue in your direct appeal, explain why: (c) Post-Conviction Proceedings: (1) Did you raise this issue in any post-conviction motion, petition, or application? Yes No (2) If your answer to Question (c)(1) is Yes, state: Type of motion or petition: Name and location of the court where the motion or petition was filed: Docket or case number (if you know): Date of the courts decision: Result (attach a copy of the courts opinion or order, if available): (3) Did you receive a hearing on your motion, petition, or application? Yes No