FORM TO BE USED BY FEDERAL PRISONER IN FILING A PETITION FOR WRIT OF HABEAS CORPUS UNDER 28 U.S.C. § 2241 IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF ARKANSAS Petitioner (Full name under which you were convicted; prison number; and full mailing address.) Vs. CIVIL ACTION NO. _______________ Respondent (Name of Warden or other authorized person having custody of petitioner.) PLEASE COMPLETE THE FOLLOWING. READ THE ENTIRE PETITION BEFORE FILLING IT OUT. ANSWER THOSE QUESTIONS WHICH PERTAIN TO YOUR TYPE OF CLAIM. 1. This petition concerns: (Check appropriate blank.) __________ a conviction __________ a sentence (CAUTION: __________ jail or prison conditions __________ prison discipline __________ __________ a parole problem other. State briefly: If you are attacking a sentence imposed under a federal judgment, you must first file a direct motion under 28 U.S.C. § 2255 in the federal court which entered the judgment.) ______________________________________________ American LegalNet, Inc. www.USCourtForms.com 2. Place of detention: ____________________________________________________________ ___________________________________________________________________________________ 3. Have you filed previous petitions for habeas corpus, motions under 28:2255, or any other applications, petitions or motions with respect to this conviction? _________ Yes __________ No If your answer above is “Yes,” give the following information: a. Name of Court: ________________________________________________________________ b. Nature of Proceeding: __________________________________________________________ c. Grounds raised: _____________________________________________________________________________ d. Result: ______________________________________________________________________ e. Date of Result: _______________________________________________________________ f. Citation or number of any written opinion or order entered pursuant to each such disposition: _____________________________________________________________________________ 4. If you did not file a motion under Section 2255 of Title 28, U.S.C., or if you filed such a motion and it was denied, state why your remedy by way of such motion is inadequate or ineffective to test the legality of your detention: _____________________________________________________________________________ 5. Are you presently represented by counsel? _________ Yes __________ No If so, name, address and phone number of counsel: ________________________________ _____________________________________________________________________________ 2 American LegalNet, Inc. www.USCourtForms.com _____________________________________________________________________________ 6. Name and location of court which imposed sentence: _____________________________________________________________________________ 7. Indictment or case number, if known: ____________________________________________ 8. Offense or offenses for which sentence was imposed: ____________________________________________________________________________ 9. Date upon which sentence was imposed and the terms of the sentence: ____________________________________________________________________________ 10. When was a finding of guilty made? (Check one.) __________ After a plea of guilty __________ After a plea of not guilty __________ After a plea of nolo contendere 11. If you were found guilty after a plea of not guilty, was that finding made by: __________ A jury __________ A judge without a jury 12. Did you appeal from the judgment of conviction or the imposition of sentence? _________ Yes __________ No 13. If you did appeal, give the following information for each appeal: a. Name of Court: _______________________________________________________________ b. Result: ______________________________________________________________________ c. Date of Result: _______________________________________________________________ d. Citation or number of opinion: __________________________________________________ e. Grounds raised: (List each one.) ____________________________________________________________________________ ____________________________________________________________________________ 3 American LegalNet, Inc. www.USCourtForms.com ____________________________________________________________________________ ____________________________________________________________________________ Note: If you appealed more than once, attach an additional sheet of the same size and give all the information requested above in question No. 13, a through e. Do not write on the reverse of pages. 14. State CONCISELY every ground on which you claim that you are being held unlawfully. Summarize briefly the facts supporting each ground. If necessary, attach a single page behind this page. CAUTION: If you fail to set forth all grounds in this petition, you may be barred from presenting additional grounds at a later date. a. Ground one: __________________________________________________________________ ____________________________________________________________________________ Supporting FACTS: b. (Tell your story BRIEFLY without citing cases or law. You are CAUTIONED that you must state facts, not conclusions, in support of your grounds. A rule of thumb to follow is – who did exactly what to violate your rights at what time or place.) Ground two: _________________________________________________________________ ____________________________________________________________________________ Supporting FACTS: c. Ground three: _______________________________________________________________ 4 American LegalNet, Inc. www.USCourtForms.com ____________________________________________________________________________ Supporting FACTS: 15. RELIEF: State briefly exactly what you want the court to do for you. Make no legal arguments. Cite no cases or statutes. Signed this ____________ day of ________________________, 20_____. Day Month Year _______________________________________ Signature of Petitioner I declare (or certify, verify or state) under penalty of perjury that the foregoing is true and correct. Executed on _________________________. (Date) _______________________________________ Signature of Petitioner 5 American LegalNet, Inc. www.USCourtForms.com