Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Pro Se Petition For Writ Of Habeas Corpus Form. This is a Indiana form and can be use in District Court Federal.
Loading PDF...
Tags: Pro Se Petition For Writ Of Habeas Corpus, AO 241, Indiana Federal, District Court
OAO 241(Rev. 10/07) (INND Rev. 3/10)
Northern District of Indiana
Pro Se Petition for Relief From a Conviction or Sentence
By a Person in State Custody
(Petition Under 28 U.S.C. § 2254 for a Writ of Habeas Corpus)
Instructions
1.
To use this form, you must be a person who is currently serving a sentence under a judgment against you in
a State court. You are asking for relief from the conviction or the sentence. This form is your petition for relief.
2.
You may also use this form to challenge a State judgment that imposed a sentence to be served in the future,
but you must fill in the name of the State where the judgment was entered. If you want to challenge a federal
judgment that imposed a sentence to be served in the future, you should file a motion under 28 U.S.C. § 2255
in the federal court that entered the judgment.
3.
M ake 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.
You must pay a fee of $5. If the fee is paid, your petition will be filed. If you cannot pay the fee, you may ask
to proceed in forma pauperis (as a poor person). To do that, you must fill out an in forma pauperis petition. 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 and the transactions for the past six months. If your account
exceeds $15.00 or if you receive $15.00 or more a month, you must pay the filing fee.
7.
In this petition, you may challenge the judgment entered by only one court. If you want to challenge a judgment
entered by a different court (either in the same State or in different States), you must file a separate petition.
8.
W hen you have completed the form, send the original to the appropriate Clerk's office:
District Court Clerk's Office
1300 S. Harrison St.
Fort W ayne, IN 46802
District Court Clerk's Office
5400 Federal Plaza
Hammond, IN 46320
District Court Clerk's Office
204 S. M ain St Room 102
South Bend, IN 46601
District Court Clerk's Office
230 North Fourth Street
P.O. Box 1498
Lafayette, IN 47901
9.
CAUTION: You m ust include in this petition all the 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 petition, you may be barred from presenting additional grounds at a later date.
10.
CAPITAL CA SES: If you are under a sentence of death, you are entitled to the assistance of counsel and
should request the appointment of counsel.
American LegalNet, Inc.
www.FormsWorkFlow.com
OAO 241(Rev. 10/07) (INND Rev. 3/10)
Page 1
NORTHERN DISTRICT OF INDIANA
PRO SE PETITION UNDER 28 U.S.C. § 2254 FOR WRIT OF
HABEAS CORPUS BY A PERSON IN STATE CUSTODY
Name (under which you were convicted):
Cause No. (assigned by clerk after filing)
Prisoner Number:
Place of Confinement :
CONVICTION AND SENTENCE
1. (a) Name and location of court that entered the judgment of conviction you are challenging: ___________________
___________________________________________________________________________________________________
(b) Criminal case number: _____________________________________________________________________________
(c) Date of sentencing: _____/_____/__________
2. Did you plead guilty? Yes
No
(d) Length of sentence: ___________________________________
3. Did you have a jury trial? Yes
No
4. List all crimes of which you were convicted in this case: ___________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
DIRECT APPEAL (do not include post-conviction relief petitions or other collateral attacks in this section)
5. Did you take a direct appeal to the Indiana Court of Appeals? Yes
(a) Case number: _____________________________________________
No
(b) Date of result:_____/_____/__________
(c) Result: ___________________________________________________________________________________________
6. Did you directly appeal (or petition to transfer) to the Indiana Supreme Court? Yes
(a) Case number: _____________________________________________
No
(b) Date of result:_____/_____/__________
(c) Result: ___________________________________________________________________________________________
7. Did you file a petition for certiorari in the United States Supreme Court? Yes
(a) Case number: _____________________________________________
No
(b) Date of result:_____/_____/__________
(c) Result: ___________________________________________________________________________________________
FIRST POST-CONVICTION RELIEF PETITION
8. Did you file a post-conviction relief petition in a State circuit or superior court? Yes
No
(a) Name and location of the court: _____________________________________________________________________
____________________________________________________________ (b) Date of filing: _____/_____/___________
(c) Case number: _____________________________________________ (d) Date of result: _____/_____/__________
(e) Result: ___________________________________________________________________________________________
9. Did you appeal to the Indiana Court of Appeals? Yes
No
(a) Case number: _____________________________________________
(b) Date of result:_____/_____/__________
(c) Result: ___________________________________________________________________________________________
American LegalNet, Inc.
www.FormsWorkFlow.com
OAO 241(Rev. 10/07) (INND Rev. 3/10)
Page 2
10. Did you appeal (or petition to transfer) to the Indiana Supreme Court? Yes
(a) Case number: _____________________________________________
No
(b) Date of result:_____/_____/__________
(c) Result: ___________________________________________________________________________________________
11. Did you file a petition for certiorari in the United States Supreme Court? Yes
(a) Case number: _____________________________________________
No
(b) Date of result:_____/_____/__________
(c) Result: ___________________________________________________________________________________________
OTHER COLLATERAL ATTACKS
12. Other than the proceedings listed above, have you previously filed any other petitions, applications, or motions
concerning this conviction or sentence in any State court? Yes
No
(a) Name and location of the court: _____________________________________________________________________
____________________________________________________________ (b) Date of filing: _____/_____/___________
(c) Case number: _____________________________________________ (d) Date of result: _____/_____/__________
(e) Result: ___________________________________________________________________________________________
(f) Did you appeal (or petition to transfer) to the Indiana Supreme Court? Yes
(g) Case number: _____________________________________________
No
(h) Date of result:_____/_____/__________
(i) Result: ___________________________________________________________________________________________
13. Have you previously challenged this conviction or sentence in a federal court? Yes
No
(a) Name and location of the federal court: ______________________________________________________________
__________________________________________________________________________________________________
(b) Nature of the proceeding: __________________________________________________________________________
(c) Federal case number: _____________________________________
(d) Date of result:_____/_____/__________
(e) Result: __________________________________________________________________________________________
14. Do you have any case or appeal challenging this conviction or sentence now pending (filed and not decided yet) in
any federal or State court? Yes
No
(a) Name and location of the court (reprint the information here even if you have listed it previously on this form):
___________________________________________________________________________________________________
(b) Nature of the proceeding: __________________________________________________________________________
(c) Case number: _____________________________________________
(d) Date of filing: _____/_____/__________
GROUNDS RAISED IN THIS HABEAS CORPUS PETITION
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 four grounds. State the facts supporting
each ground.
CAUTION: To proceed in the federal court, you must ordinarily first exhaust (use up) your available
State-court remedies on each ground on which you request action by the federal court. Also, if you fail
to set forth all the grounds in this petition, you may be barred from presenting additional grounds at
a later date.
American LegalNet, Inc.
www.FormsWorkFlow.com
OAO 241(Rev. 10/07) (INND Rev. 3/10)
Page 3
15. GROUND ONE: ____________________________________________________________________________________
______________________________________________________________________________________________________
(a) Supporting facts (Do not argue or cite law. Just state the specific facts that support your claim.):
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
(b) Did you present Ground One to the Indiana Supreme Court? Yes - Explain how.
No - Explain why not.
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
_______________________________________________________________________________________________________
GROUND TW O: _______________________________________________________________________________________
______________________________________________________________________________________________________
(a) Supporting facts (Do not argue or cite law. Just state the specific facts that support your claim.):
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
(b) Did you present Ground Two to the Indiana Supreme Court? Yes - Explain how.
No - Explain why not.
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
American LegalNet, Inc.
www.FormsWorkFlow.com
OAO 241(Rev. 10/07) (INND Rev. 3/10)
Page 4
GROUND THREE: _______________________________________________________________________________________
______________________________________________________________________________________________________
(a) Supporting facts (Do not argue or cite law. Just state the specific facts that support your claim.):
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
(b) Did you present Ground Three to the Indiana Supreme Court? Yes - Explain how.
No -Explain why not.
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
GROUND FOUR: _______________________________________________________________________________________
______________________________________________________________________________________________________
(a) Supporting facts (Do not argue or cite law. Just state the specific facts that support your claim.):
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
(b) Did you present Ground Four to the Indiana Supreme Court? Yes - Explain how.
No - Explain why not.
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
American LegalNet, Inc.
www.FormsWorkFlow.com
OAO 241(Rev. 10/07) (INND Rev. 3/10)
Page 5
TIM ELINESS OF PETITION
The Antiterrorism and Effective Death Penalty Act of 1996 ("AEDPA") as contained in 28 U.S.C. § 2244(d) provides
in part that:
(1) A one-year period of limitation shall apply to an application for a writ of habeas corpus by a person in
custody pursuant to the judgment of a State court. The limitation period shall run from the latest of (A) the date on which the judgment became final by the conclusion of direct review or the
expiration of the time for seeking such review;
(B) the date on which the impediment to filing an application created by State action in violation
of the Constitution or laws of the United States is removed, if the applicant was prevented from
filing by such State action;
(C) the date on which the constitutional right asserted was initially recognized by the Supreme
Court, if the right has been newly recognized by the Supreme Court and made retroactively
applicable to cases on collateral review; or
(D) the date on which the factual predicate of the claim or claims presented could have been
discovered through the exercise of due diligence.
(2) The time during which a properly filed application for State post-conviction or other collateral review
with respect to the pertinent judgment or claim is pending shall not be counted toward any period of
limitation under this subsection.
16. Explain why this petition is timely under the provisions of 28 U.S.C. § 2244(d).
_______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
_____________________________________________________________________________________________________
PRAYER FOR RELIEF
Therefore, petitioner asks that the Court grant the following relief: ____________________________________
______________________________________________________________________________________________________
______________________________________________________ or any other relief to which petitioner m ay be entitled.
DECLARATION AND SIGNATURE
I declare under penalty of perjury that the foregoing is true and correct and that this Petition for W rit of Habeas
Corpus was signed and placed in the prison mailing system on _____/_____/__________. (month, date, year).
______________________________________________
Signature of Petitioner*
*If the person signing is not petitioner, state relationship to petitioner and explain why petitioner is not signing this petition.
American LegalNet, Inc.
www.FormsWorkFlow.com
