(Rev. 7/2015) Petition for Relief From a Conviction or Sentence By a Person in State Custody (Petitioner 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 serv a sentence under a judgment against you in a state court. This ing form is your petition for relief from that conviction or sentence. 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. Make 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. Y may submit additional pages if necessary. If youdo not fill out the ou form properly, you will be asked to subm additional or corrected information. If you want to subm a brief or arguments, you it it 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 m fill out the enclosed AO 240 form. Also, you m submit a certificate ust ust signed by an officer at the institution where you are confined s howing the amount of money that the institution is holding for you. 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. When you have completed the form, send the original and two copies to the Clerk of the United States District Court at one of the following addresses: Clerk, U.S. District Court 399 Federal Bldg. 110 Michigan St., NW Grand Rapids, MI 49503 Clerk, U.S. District Court 314 Federal Bldg. P.O. Box 698 Marquette, MI 49855 9. Clerk, U.S. District Court 107 Federal Bldg. 410 W. Michigan Ave. Kalamazoo, MI 49007 Clerk, U.S. District Court 113 Federal Bldg. 315 W. Allegan Lansing, MI 48933 CAUTION: You must 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. American LegalNet, Inc. www.FormsWorkFlow.com (Rev. 11/2012) PETITION UNDER 28 USC � 2254 FOR WRIT OF HABEAS CORPUS BY A PERSON IN STATE CUSTODY United States District Court Name (under which you were convicted): Place of Confinement: Name of Petitioner (include name under which convicted) v. The Attorney General of the State of: District Docket or Case No.: Prisoner No.: Name of Respondent (authorized person having custody) PETITION 1. (a) Name and location of court that entered the judgment of conviction you are challenging: (b) Criminal docket or case number: 2. 3. Date of judgment of conviction: Identify all counts and crimes for which you were convicted and sentenced in this case: 4. Length of sentence for each count or crime for which you were convicted in this case: 5. (a) What was your plea? Not guilty 9 Guilty 9 Nolo contendere (no contest) 9 -1American LegalNet, Inc. www.FormsWorkFlow.com (b) If you entered a guilty plea to one count or charge, and a not guilty plea to another count or charge, give details: 6. If you went to trial, what kind of trial did you have? (Check one) (a) Jury 9 (b) Judge only 9 Did you testify at the trial? Yes 9 No 9 Did you file a direct appeal to the Michigan Court of Appeals from the judgment of conviction? Yes 9 No 9 If you did appeal, answer the following: (a) Date you filed: (b) Docket or case number: (c) Result: (d) Date of result: (e) Grounds raised: 7. 8. 9. Please submit, if available, a copy of any brief filed on your behalf and a copy of the decision by the court. (g) Did you seek further review of the decision on appeal by the Michigan Supreme Court? Yes 9 No 9 If yes, answer the following: (1) Date you filed: (2) Docket or case number: (3) Result: (4) Date of result: -2American LegalNet, Inc. www.FormsWorkFlow.com (5) Grounds raised: Please submit, if available, a copy of any brief filed on your behalf and a copy of the decision by the court. (h) Did you file a petition for certiorari in the United States Supreme Court? Yes 9 No 9 If yes, answer the following: (1) Date you filed: (2) Docket or case number: (3) Result: (4) Date of result: (5) Grounds raised: 10. Did you file a motion for relief from judgment pursuant to Subchapter 6.500 of the Michigan Court Rules with respect to the judgment of conviction and sentence? Yes 9 No 9 11. If your answer to 10 was "yes," give the following information: (a) (1) Date you filed: (2) Name of court: (3) Docket or case number: (4) Grounds raised: (5) Did you receive a hearing where evidence was given on your motion? Yes 9 No 9 (6) Result: (6) Date of result: Please submit, if available, a copy of any brief filed on your behalf and a copy of the decision by the court. -3American LegalNet, Inc. www.FormsWorkFlow.com (b) If you sought further review of the decision in the Michigan Court of Appeals, please answer the following: (1) Date you filed: (2) Docket or case number: (3) Result: (4) Date of result: (5) Grounds raised: Please submit, if available, a copy of any brief filed on your behalf and a copy of the decision by the court. (c) If you sought further review of the decision in the Michigan Supreme Court, please answer the following: (1) Date you filed: (2) Docket or case number: (3) Result: (4) Date of result: (5) Grounds raised: Please submit, if available, a copy of any brief filed on your behalf and a copy of the decision by the court. 12. Other than a direct appeal or a m otion for relief from judgment, have you previously filed any petitions, applications, or motions with respect to this judgment in any court, state or federal? Yes 9 No 9 13. If your answer to 12 was "yes," give the following inform ation: [Attach additional sheets of paper, if necessary, to answer the following for each petition, application, or motion you filed.] (a) (1) Date you filed: (2) Name of court: (2) D