UNITED STATES COURT OF APPEALS FOR THE SECOND CIRCUIT A PPLICATION FOR L EAVE TO F ILE A S ECOND OR S UCCESSIVE H ABEAS C ORPUS P ETITION 28 U.S.C. § 2244(b) B Y A P RISONER IN S TATE C USTODY N A M E: P LACE OF C O N F IN E M E N T: P RISONER N UMBER : INSTRUCTIONS--READ CAREFULLY (1) This application must be legibly handwritten or typewritten and signed by the applicant under penalty of perjury. Any false statement of a material fact may serve as the basis for prosecution and conviction for perjury. (2) All questions must be answered concisely in the proper space on the form. (3) The Judicial Conference of the United States has adopted the 8½ x 11 inch paper size for use throughout the federal judiciary and directed the elimination of the use of legal size paper. All pleadings must be on 8½ x 11 inch paper, otherwise we cannot accept them. (4) All applicants seeking leave to file a second or successive petition are required to use this form, except in capital cases. In capital cases only, the use of this form is optional. (5) Additional pages are not permitted except with respect to additional grounds for relief and facts which you rely upon to support those grounds. Do not submit separate petitions, motions, briefs, arguments, etc., except in capital cases. Page 1 June 20, 1996 American LegalNet, Inc. www.USCourtForms.com (6) In accordance with the "Anti-Terrorism and Effective Death Penalty Act of 1996," as codified at 28 U.S.C. § 2244(b), effective April 24, 1996, before leave to file a second or successive petition can be granted by the United States Court of Appeals, it is the applicant' s burden to make a prima facie showing that he satisfies either of the two conditions stated below and in 28 U.S.C. § 2244(b). (b)(1) a claim presented in a second or successive habeas corpus application under [28 U.S.C.] section 2254 that was presented in a prior application shall be dismissed. (2) a claim presented in a second or successive habeas corpus application under [28 U.S.C.] section 2254 that was not presented in a prior application shall be dismissed unless— (A) the applicant shows that the claim relies on a new rule of constitutional law, made retroactive to cases on collateral review by the Supreme Court, that was previously unavailable; or (B)(I) the factual predicate for the claim could not have been discovered previously through the exercise of due diligence; and (ii) the facts underlying the claim, if proven and viewed in light of the evidence as a whole, would be sufficient to establish by clear and convincing evidence that, but for constitutional error, no reasonable factfinder would have found the applicant guilty of the underlying offense. (7) When this application is fully completed, the original and four copies must be mailed to: Clerk of Court United States Court of Appeals for the Second Circuit United States Courthouse 40 Foley Square New York, New York 10007 Page 2 American LegalNet, Inc. www.USCourtForms.com APPLICATION 1. (a) (b) Name and location of court which entered the judgment of conviction under attack __________________________________________________________________ Case number _______________________________________________________ 2. Date of judgment of conviction ______________________________________________ 3. Length of sentence _____________ Sentencing Judge ____________________________ 4. Nature of offense or offenses for which you were convicted:_______________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 5. Have you ever filed a post-conviction petition, application, or motion for collateral relief in any federal court related to this conviction and sentence? Yes ( ) No ( ) If "yes", how many times? _____________ (if more than one, complete 6 and 7 below as necessary) (a) Name of court _________________________________________________________ (b) Case number __________________________________________________________ (c) Nature of proceeding____________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ (d) Grounds raised (list all grounds; use extra pages if necessary)___________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ (e) Did you receive an evidentiary hearing on your petition, application, or motion? Yes ( ) No ( ) (f) Result ________________________________________________________________ _________________________________________________________________________ (g) Date of result __________________________________________________________ 6. As to any second federal petition, application, or motion, give the same information: (a) Name of court _________________________________________________________ (b) Case number __________________________________________________________ Page 3 American LegalNet, Inc. www.USCourtForms.com (c) Nature of proceeding ___________________________________________________ ________________________________________________________________________ ________________________________________________________________________ (d) Grounds raised (list all grounds; use extra pages if necessary) ___________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ _________________________________________________________________________ (e) Did you receive an evidentiary hearing on your petition, application, or motion? Yes ( ) No ( ) (f) Result ________________________________________________________________ ________________________________________________________________________ (g) Date of result __________________________________________________________ 7. As to any third federal petition, application, or motion, give the same information: (a) Name of court _________________________________________________________ (b) Case number____________________________________________________________ (c) Nature of proceeding ____________________________________________________ ________________________________________________________________________ ________________________________________________________________________ (d) Grounds raised (list all grounds; use extra pages if necessary)___________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ (e) Did you receive an evidentiary hearing on your petition, application, or motion? Yes ( ) No ( ) (f) Result ________________________________________________________________ ________________________________________________________________________ (g) Date of result __________________________________________________________ 8. Did you appeal the result of any action taken on your federal petition, application, or motion? (Use extra pages to reflect additional petitions if necessary) (1) First petition, etc. No ( ) Yes ( ) Appeal No. __________________ (2) Second petition etc. No ( ) Yes ( ) Appeal No. __________________ (3) Third petition, etc. No ( ) Yes ( ) Appeal No. __________________ Page 4 American LegalNet, Inc. www.USCourtForms.com 9. If you did not appeal from the adverse action on any petition, application, or motion, explain briefly why you did not: _____________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 10. State concisely every ground on which you now claim that you are being held unlawfully. Summarize briefly the facts supporting each ground. A. Ground one: _______________________________________________________ __________________________________________________________________ Supporting FACTS (tell your story briefly without citing cases or law): ___________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ Was this claim raised in a prior federal petition, application, or motion? Yes ( ) No ( ) Does this claim rely on a "new rule of law?" Yes ( ) No ( ) If "yes," state the new rule of law (give case name and citation): __________________________________________________________________ __________________________________________________________________ Does this claim rely on "newly discovered evidence?" Yes ( ) No ( ) If "yes," briefly state the newly discovered evidence, and why it was not previously available to you ____________________________________________ ___________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ Page 5 American LegalNet, Inc. www.USCourtForms.com B. Ground two: _______________________________________________________ __________________________________________________________________ Supporting FACTS (tell your story briefly without citing cases or law): __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ Was this claim raised in a prior federal petition, application, or motion? Yes ( ) No ( ) Does this claim rely on a "new rule of law?" Yes ( ) No ( ) If "yes," state the new rule of law (give case name and citation):_____________ __________________________________________________________________ __________________________________________________________________ Does this claim rely on "newly discovered evidence?" Yes ( ) No ( ) If "yes," briefly state the newly discovered evidence, and why it was not previously available to you ____________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ [Additional grounds may be asserted on extra pages if necessary] 11. Do you have any motion or appeal now pending in any court as to the judgment now under attack? Yes ( ) No ( ) If yes, name of court _________________________Case number__________________ Page 6 American LegalNet, Inc. www.USCourtForms.com Wherefore, applicant prays that the United States Court of Appeals for the Second Circuit grant an Order Authorizing the District Court to Consider Applicant' s Second or Successive Petition for a Writ of Habeas Corpus under 28 U.S.C. § 2254. ____________________________________ Applicant’s Signature I declare under Penalty of Perjury that my answers to all the questions in this Application are true and correct. Executed on _______________________ [date] ____________________________________ Applicant' s Signature PROOF OF SERVICE Applicant must send a copy of this application and all attachments to the attorney general of the state in which applicant was convicted. I certify that on _____________________________, I mailed a copy of this Application* and all [date] attachments to __________________________________________________________________ at the following address: ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________ Applicant' s Signature * Pursuant to Fed.R.App.P. 25(a), “Papers filed by an inmate confined in an institution are timely filed if deposited in the institution's internal mail system on or before the last day of filing. Timely filing of papers by an inmate confined in an institution may be shown by a notarized statement or declaration (in compliance with 28 U.S.C. § 174 6) setting forth the date o f deposit and stating that first-class postage ha s been prepaid.” Page 7 American LegalNet, Inc. www.USCourtForms.com