UNITED STATES COURT OF APPEALS FOR THE SECOND CIRCUIT A PPLICATION FOR L EAVE TO F ILE A S ECOND OR S UCCESSIVE M OTION TO V ACATE , S ET A SIDE OR C ORRECT S ENTENCE 28 U.S.C. § 2255 BY A P RISONER IN F EDERAL C USTODY NA M E: PLACE OF CONFINEMENT: PRISONER NUMBER : 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. (6) In accordance with the "Antiterrorism and Effective Death Penalty Act of 1996," as codified at 28 U.S.C. § 2255, effective April 24, 1996, before leave to file a second or successive motion can be granted by the United States Court of Appeals, it is the Page 1 American LegalNet, Inc. www.USCourtForms.com applicant' s burden to make a prima facie showing that he satisfies either of the two conditions stated below. A second or successive motion must be certified as provided in [28 U.S.C.] section 2255 by a panel of the appropriate court of appeals to contain— (1) newly discovered evidence that, if proven and viewed in light of the evidence as a whole, would be sufficient to establish by clear and convincing evidence that no reasonable factfinder would have found the movant guilty of the offense; or (2) a new rule of constitutional law, made retroactive to cases on collateral review by the Supreme Court, that was previously unavailable. (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) State and division of the United States District 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. Related to this conviction and sentence, have you ever filed a motion to vacate in any federal court? 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 motion? Yes ( ) No ( ) (f) Result ________________________________________________________________ ________________________________________________________________________ (g) Date of result __________________________________________________________ 6. As to any second federal motion, give the same information: (a) Name of court _________________________________________________________ (b) Case number __________________________________________________________ (c) Nature of proceeding ____________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Page 3 American LegalNet, Inc. www.USCourtForms.com (d) Grounds raised (list all grounds; use extra pages if necessary)___________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ (e) Did you receive an evidentiary hearing on your motion? Yes ( ) No ( ) (f) Result ________________________________________________________________ ________________________________________________________________________ (g) Date of result __________________________________________________________ 7. As to any third federal 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 motion? Yes ( ) No ( ) (f) Result ________________________________________________________________ ________________________________________________________________________ (g) Date of result __________________________________________________________ 8. Did you appeal the result of any action taken on your federal motion? (Use extra pages to reflect additional petitions if necessary) (1) First motion No ( ) Yes ( ) Appeal No. __________________ (2) Second motion No ( ) Yes ( ) Appeal No. __________________ (3) Third motion No ( ) Yes ( ) Appeal No. __________________ 9. If you did not appeal from the adverse action on any motion, explain briefly why you did not: _____________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Page 4 American LegalNet, Inc. www.USCourtForms.com 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 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 ___________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ B. Ground two: _______________________________________________________ __________________________________________________________________ Supporting FACTS (tell your story briefly without citing cases or law): __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ ________________________________________________________________ __________________________________________________________________ Was this claim raised in a prior motion? Yes ( ) No ( ) Page 5 American LegalNet, Inc. www.USCourtForms.com 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 additional 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___________________ 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 Motion to Vacate under 28 U.S.C. § 2255. ____________________________________ 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 Page 6 American LegalNet, Inc. www.USCourtForms.com PROOF OF SERVICE Applicant must send a copy of this application and all attachments to the United States Attorney’s office in the district in which you were convicted. I certify that on ______________________________, I mailed a copy of this Application* and [date] all 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