Approved, SCAO Original - Court 1st copy - Prosecutor 2nd copy - Defendant 3rd copy - Defendant attorney STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY ORI Court CASE NO. MOTION FOR RELIEF FROM JUDGMENT address Defendant name, address, and inmate no. Court telephone no. MI- THE PEOPLE OF THE STATE OF MICHIGAN v To be completed by the court. CTN/TCN SID DOB INSTRUCTIONS: Answer each question as completely as you can. If you need more space to answer any question, you may attach extra pages. You may also attach documents, affidavits, or a brief, if you wish. Only one motion for relief may be filed, except as indicated in MCR 6.502(G)(2). Information for items 1 and 2 is on both your judgment of sentence and basic information sheet, which are available at the prison record office. 1. I was found guilty on Date CONVICTED BY Count Plea* Court Jury DISMISSED BY* of the crime(s) stated below. CRIME CHARGE CODE(S) MCL citation/PACC Code *For plea: insert "G" for guilty plea, "NC" for nolo contendere, or "MI" for guilty but mentally ill. For dismissal: insert "D" for dismissed by court or "NP" for dismissed by prosecutor/plaintiff. 2. I was sentenced as stated below by Hon. Name of judge Count . JAIL CREDIT Mos. Days SENTENCE MINIMUM MAXIMUM DATE SENTENCE Years Mos. Days Years Mos. DATE BEGINS OTHER INFORMATION 3. Fill in the charts below with the information requested about the court proceedings in your case and the names of the attorneys who represented you. a. Trial Level - All Proceedings. From arrest to sentencing, including lineups and other proceedings. NAME OF PROCEEDING NAME OF ATTORNEY NAME OF PROCEEDING NAME OF ATTORNEY b. Postconviction - All Proceedings. State and federal, including appeals, posttrial motions, and habeas petitions. COURT DOCKET NO. NAME OF PROCEEDING NAME OF ATTORNEY RESULT DATE OF RESULT (Continued on the other side.) CC 257 (3/10) MOTION FOR RELIEF FROM JUDGMENT American LegalNet, Inc. www.FormsWorkFlow.com MCR 6.502, MCR 6.503 4. Appointment of Counsel. Do you want an attorney appointed? 5. Grounds and Relief. a. What action do you want the court to take? Yes No If yes, complete and attach a financial schedule. b. What are the legal grounds for the relief you want? You must raise all the issues you know about. You may not be allowed to raise additional issues in the future. Use extra sheets of paper, if necessary. ISSUE ONE: Supporting facts: ISSUE TWO: Supporting facts: ISSUE THREE: Supporting facts: ISSUE FOUR: Supporting facts: I declare that the statements above are true to the best of my information, knowledge, and belief. Date Signature PROOF OF SERVICE I certify that on this date I served a copy of this motion upon the prosecutor by Date Signature personal service. first-class mail. American LegalNet, Inc. www.FormsWorkFlow.com