1 2 3 UNITED STATES DISTRICT COURT 4 NORTHERN DISTRICT OF CALIFORNIA 5 6 (Full Name of Petitioner) | | | Petitioner, 7 CASE NO. DEATH PENALTY CASE | 8 v. (Name of Warden) | | | 9 Respondent. 10 APPLICATION FOR APPOINTMENT OF COUNSEL; REQUEST FOR STAY OF EXECUTION | 11 My name is . I am a prisoner in state custody under 12 sentence of death. I was convicted and sentenced in the County 13 Superior Court. The California Supreme Court affirmed my death sentence on , 14 20 . My scheduled execution date is , 20 . 15 I was tried and I am being held in violation of my federal constitutional rights. The 16 attorney who represented me in my most recent state court proceeding in connection with my 17 conviction and death sentence has informed me that he/she is unable to represent me in federal 18 habeas corpus proceedings. I am indigent and have substantially no assets. I hereby request that 19 the Court appoint an attorney to represent me in my habeas corpus case in this Court. I also 20 request that the Court stay my execution at this time. 21 I have filed the following federal applications for relief with respect to my conviction and 22 death sentence: 23 24 25 . 26 I declare under penalty of perjury that the foregoing is true and correct. 27 28 Dated: [Signature of Prisoner] 2001 © American LegalNet, Inc.