UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT APPLICATION FOR A WRIT OF HABEAS CORPUS PURSUANT TO 28 U.S.C. § 2254 BY A PERSON IN STATE CUSTODY , Petitioner, Full Name and Prisoner Number Case No. ______________ (To be supplied by the Court) Complete Prison Address (Place of Confinement) v. , Respondent, (Name of Warden or authorized person having custody of petitioner) (Do not use et al.) and , Additional Respondent. (List additional persons having custody of petitioner, if any) Note: If the applicant is challenging a judgment which imposed a sentence to be served in the future, applicant must fill in the name of the state where the judgment of conviction was entered. If the applicant has a sentence to be served in the future under a federal judgment, which he/she wishes to challenge, he/she should file a motion under 28 U.S.C. § 2255, in the federal court which entered the judgment. American LegalNet, Inc. www.FormsWorkFlow.com CONVICTION BEING CHALLENGED 1) Name and location of the court which entered the judgment of conviction you are challenging 2) 3) 4) 5) Date judgment of conviction was entered Case number (in state court) Type and length of sentence imposed Nature of the offense involved (all counts) 6) What was your plea? (check one) Not Guilty Guilty Nolo Contendere 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: 7) 8) If you entered a plea of guilty pursuant to a plea bargain, state the terms and conditions of the agreement 9) 10) Kind of trial (check one) Jury No Judge only Did you testify at trial? Yes 2 American LegalNet, Inc. www.FormsWorkFlow.com DIRECT APPEAL 11) 12) Did you appeal from the judgment of conviction? Yes No If you did not appeal, explain briefly why you did not: ______________________ (a) 13) Did you seek permission to file a late appeal? Yes No If you did appeal, answer the following: (a) (b) (c) (d) (e) (f) Name of court: ______________________________________________ Docket number (if you know): __________________________________ Result (attach a copy if you have one): ___________________________ Date of result (if you know): ____________________________________ Citation to the case (if you know): _______________________________ Grounds raised: _____________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ 14) If your appeal was denied by the Connecticut Appellate Court, did you file a petition for certification with the Connecticut Supreme Court? Yes___ No ___ If you sought certification, answer the following: (a) (b) (c) Date of decision (if you know): __________________________________ Citation to the case (if you know): _______________________________ Grounds raised (or attach a copy of the petition for certification if you have 3 American LegalNet, Inc. www.FormsWorkFlow.com 15) one): _______________________________________________________ ________________________________________________________________ ________________________________________________________________ 16). Did you file a petition for certiorari in the United States Supreme Court? Yes____ No____ If yes, answer the following: (a) (b) Docket number (if you know): ___________________________________ Result: ____________________________________________________ ________________________________________________________________ (c) (d) (e) Date of result (if you know): ____________________________________ Citation to the case (if you know): _______________________________ Grounds raised: _____________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ 4 American LegalNet, Inc. www.FormsWorkFlow.com POST-CONVICTION PROCEEDINGS 17) 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 state court? Yes No If your answer to Question 17 was "Yes," give the following information: (a) FIRST petition, application or motion. (1) (2) (3) (4) Name of court: Docket number (if you know): _____________________________ Nature of proceeding: Grounds raised: 18) __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ (5) Did you receive an evidentiary hearing on your petition, application or motion? Yes No (6) (7) Result: Date of result (if you know): (8) Did you appeal the result to the highest state court having jurisdiction? Yes No If you did appeal, give the name of the court where the appeal was filed, the result, the case number, citation and date of the court's decision (or attach a copy of the court's opinion or order) (9) If you did not appeal, briefly explain why you did not: 5 American LegalNet, Inc. www.FormsWorkFlow.com (10) If your appeal was decided by the Connecticut Appellate Court, did you file a petition for certification to appeal the decision to the Connecticut Supreme Court? Yes ___ No ___ (11) If you sought certification, give the citation and date of the court's decision or attach a copy of the decision. Also attach a copy of the petition for certification or list the issues for which certification was sought. ____________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ (b) As to any SECOND petition, application or motion, give the following information: (1) (2) (3) (4) Name of court: Docket number (if you know): _____________________________ Nature of proceeding: Grounds raised: __________________________________________________________ __________________________________________________________ _________________________________________