CV-69 (05/18)PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN STATE CUSTODY (28 U.S.C. 247 2254) Page 1 of 11 NAME PRISON IDENTIFICATION/BOOKING NO. ADDRESS OR PLACE OF CONFINEMENT Note:It is your responsibility to notify the Clerk of Court in writing of anychange of address. If represented by an attorney, provide his or hername, address, telephone and facsimile numbers, and e-mail address.UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIA FULL NAME (Include name under which you were convicted )Petitioner,CASE NUMBER:CV To be supplied by the Clerk of the United States District Courtv. NAME OF WARDEN, SUPERINTENDENT, JAILOR, OR AUTHORIZEDPERSON HAVING CUSTODY OF PETITIONERRespondent.G AMENDEDPETITION FOR WRIT OF HABEAS CORPUSBY A PERSON IN STATE CUSTODY28 U.S.C. 247 2254PLACE/COUNTY OF CONVICTION PREVIOUSLY FILED, RELATED CASES IN THIS DISTRICT COURT(List by case number)CV CV INSTRUCTIONS - PLEASE READ CAREFULLY1.To use this form, you must be a person who either is currently serving a sentence under a judgment against you in a California state court, or will be serving a sentence in the future under a judgment against you in a California state court. You are asking for relief from the conviction and/or the sentence. This form is your petition for relief.2.In this petition, you may challenge the judgment entered by only one California state court. If you want to challenge judgments entered by more than one California state court, you must file a separate petition for each court.3.Make sure the form is typed or neatly handwritten. 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.4. Answer all the questions. You do not need to cite case law, but you do need to state the federal legal theory and operative facts in support of each ground. 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 legal brief or arguments, you may attach a separate memorandum. You must include in this petition all the grounds for relief from the conviction and/or sentence that you challenge. You must also state the facts that support each ground. If you fail to set forth all the grounds in this petition, you may be barred from presenting additional grounds at a later date.You must pay a fee of $5.00. If the fee is paid, your petition will be filed. If you cannot afford the fee, you may ask to proceed in forma pauperis (as a poor person). To do that, you must fill out and sign the declaration of the last two pages of the form. Also, you must have an authorized officer at the penal institution complete the certificate as to the amount of money and securities on deposit to your credit in any account at the institution. If your prison account exceeds $25.00, you must pay the filing fee.7.When you have completed the form, send the original and two copies to the following address:Clerk of the United States District Court for the Central District of CaliforniaUnited States CourthouseATTN: Intake/Docket Section255 East Temple Street, Suite TS-134Los Angeles, California 90012 5.6. American LegalNet, Inc. www.FormsWorkFlow.com CV-69 (05/18)PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN STATE CUSTODY (28 U.S.C. 247 2254) Page 2 of 11PLEASE COMPLETE THE FOLLOWING (check appropriate number):This petition concerns:1. a conviction and/or sentence.2. prison discipline.3. a parole problem.4. other.PETITION1.Venuea.Place of detention b.Place of conviction and sentence 2.Conviction on which the petition is based (a separate petition must be filed for each conviction being attacked).a.Nature of offenses involved (include all counts) : b.Penal or other code section or sections: c.Case number: d.Date of conviction: e.Date of sentence: f.Length of sentence on each count: g.Plea (check one): Not guilty Guilty Nolo contendereh.Kind of trial (check one): Jury Judge only3.Did you appeal to the California Court of Appeal from the judgment of conviction? Yes NoIf so, give the following information for your appeal (and attach a copy of the Court of Appeal decision if available):a.Case number: b.Grounds raised (list each):(1) (2) American LegalNet, Inc. www.FormsWorkFlow.com CV-69 (05/18)PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN STATE CUSTODY (28 U.S.C. 247 2254) Page 3 of 11(3) (4) (5) (6) c.Date of decision: d.Result 4.If you did appeal, did you also file a Petition for Review with the California Supreme Court of the Court of Appealdecision? Yes NoIf so, give the following information (and attach copies of the Petition for Review and the Supreme Court ruling if available):a.Case number: b.Grounds raised (list each):(1) (2) (3) (4) (5) (6) c.Date of decision: d.Result 5.If you did not appeal:a.State your reasons b.Did you seek permission to file a late appeal? Yes No6.Have you previously filed any habeas petitions in any state court with respect to this judgment of conviction?G YesG NoIf so, give the following information for each such petition (use additional pages, if necessary, and attach copies of the petitions and therulings on the petitions if available):a.(1) Name of court: (2) Case number: (3) Date filed (or if mailed, the date the petition was turned over to the prison authorities for mailing): American LegalNet, Inc. www.FormsWorkFlow.com CV-69 (05/18)PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN STATE CUSTODY (28 U.S.C. 247 2254) Page 4 of 11(4) Grounds raised (list each):(a) (b) (c) (d) (e) (f) (5) Date of decision: (6) Result (7) Was an evidentiary hearing held? Yes Nob.(1) Name of court: (2) Case number: (3) Date filed (or if mailed, the date the petition was turned over to the prison authorities for mailing): (4) Grounds raised (list each):(a) (b) (c) (d) (e) (f) (5) Date of decision: (6) Result (7) Was an evidentiary hearing held? Yesc.(1) Name of court: (2) Case number: (3) Date filed (or if mailed, the date the petition was turned over to the prison authorities for mailing): (4) Grounds raised (list each):(a) (b) (c) (d) (e) (f) No American LegalNet, Inc. www.FormsWorkFlow.com CV-69 (05/18)PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN STATE CUSTODY (28 U.S.C. 247 2254) Page 5 of 11(5) Date of decision: (6) Result (7) Was an evidentiary hearing held? Yes No8.For this petition, 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 five grounds. Summarize briefly the facts supporting each ground. For example, if you are claiming ineffective assistance of counsel, youmust state facts specifically setting forth what your attorney did or failed to do.CAUTION:Exhaustion Requirement: In order to proceed in federal court, you must ordinarily first exhaustyour state court remedies with respect to each ground on which you are requesting relief from thefederal court. This means that, prior to seeking relief from the federal court, you first must present all of your grounds to the California Supreme Court. a.Ground one: (1) Supporting FACTS: (2) Did you raise this claim on direct appeal to the California Court of Appeal? Yes No(3) Did you raise this claim in a Petition for Review to the California Supreme Court? Yes No(4) Did you raise this claim in a habeas petition to the California Supreme Court? Yes Nob.Ground two: (1) Supporting FACTS: 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):7. American LegalNet, Inc. www.FormsWorkFlow.com CV-69 (05/18)PETITION FOR WRIT OF HABEAS CORPUS BY A PERSON IN STATE CUSTODY (28 U.S.C. 247 2254) Page 6 of 11(1) Supporting FACTS: (2) Did you raise this claim on direct appeal to the California Court of Appeal?G YesG No(3) Did you raise this claim in a Petition for Review to the California Supreme Court?G YesG No(4) Did you raise this claim in a habeas petition to the California Supreme Court?G YesG Nod.Ground four: (1) S