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Petition For Relief Under The Post Conviction Remedies Act Form. This is a Utah form and can be use in Miscellaneous Statewide.
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Tags: Petition For Relief Under The Post Conviction Remedies Act, Utah Statewide, Miscellaneous
Person Completing Form:
Address:
Telephone Number:
Bar Number:
In the District Court of the ______________ Judicial District
___________________ County
Petition for Relief Under the
Post-Conviction Remedies Act
___________________________________
PETITIONER,
Utah Code Ann. §78-35a-101, et seq.
Utah Rules of Civil Procedure 65C
vs.
___________________________________
RESPONDENT.
Civil
Number: _______________________
Judge: _________________________
NOTICE TO THE PETITIONER: BEFORE COMPLETING THIS FORM, PLEASE READ IT
CAREFULLY. IF YOU HAVE ANY QUESTIONS, CONTACT AN ATTORNEY. COURT
CLERKS ARE NOT ALLOWED TO GIVE LEGAL ADVICE. ATTACH ADDITIONAL
SHEETS OF PAPER AS NECESSARY TO COMPLETE YOUR ANSWERS. SHOW THE
QUESTION NUMBER FROM THIS FORM ON THE ADDITIONAL SHEET OF PAPER.
I. NAME OF RESPONDENT (Check One)
Conviction of Felony:
Conviction of Misdemeanor or Ordinance :
Conviction of Misdemeanor or Ordinance :
State Of Utah
County of: ____________________
Municipality of: ________________
II. IDENTIFICATION OF CURRENT AND RELATED CASES
1(a). Name of court that entered the judgment being challenged: _____________________
(b) Location of court: ________________________
(c) Case number: ____________________________
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2. Date of judgment being challenged: ______________________
3. Sentence:________________________________________________________________
_________________________________________________________________________________
___________________________________________________________________________
4. Nature of offense involved (all counts):________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
__________________________________________________________________
5. What was your plea? (Check One)
Not guilty
Guilty
No Contest
Guilty and Mentally ill
Not guilty by reason of insanity
6. If you entered a plea of guilty to some counts, and a not guilty plea to other counts, give your
plea to each count: _________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
____________________________________________________________
7. If you pled not guilty or not guilty by reason of insanity, was the trial before a
Jury
Judge
8. Did you testify at the trial?
Yes
No
9. Did you appeal from the conviction or sentence?
Yes
No
10. If your answer is "yes," provide the following information:
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Person Completing Form:
Address:
Telephone Number:
Bar Number:
(a) Name of Appellate Court: ______________________________________________
(b) Case number: ________________________________________________________
(c) Result: ______________________________________________________________
_____________________________________________________________________________
(d) Date of result or citation of opinion: ______________________________________
(e) Grounds raised: _______________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
__________________________________________________________________
(f) Did you seek further review of this appeal?
Yes
No
(g) If your answer is "yes," provide the following information:
(1) Name of Reviewing Court: __________________________________________
(2) Case number: _____________________________________________________
(3) Result: ___________________________________________________________
______________________________________________________________________________
(4) Date of result or citation of opinion: ___________________________________
(5) Grounds raised: ____________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
__________________________________________________________________
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11. If you did not appeal from your conviction or sentence, why not? _________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
__________________________________________________________________
12(a). Other than your direct appeal from your conviction or sentence, have you filed any
petitions, applications, or motions with respect to this conviction or sentence in any court, state or
federal?
Yes
No
(b) If your answer is "yes," provide the following information:
(1) Name of court: _______________________________________________________
(2) Case number: ________________________________________________________
(3) Result: ______________________________________________________________
(4) Date of result or citation of opinion: ______________________________________
(5) Grounds raised: _______________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
__________________________________________________________________
(c) Did you receive an evidentiary hearing on your petition, application, or motion?
Yes
No
(d) Did you appeal the decision on your petition, application, or motion?
Yes
No
(e) If your answer is "yes," provide the following information:
(1) Name of court: _______________________________________________________
(2) Case number: ________________________________________________________
(3) Result: ______________________________________________________________
(4) Date of result or citation of opinion: ______________________________________
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Person Completing Form:
Address:
Telephone Number:
Bar Number:
(5) Grounds raised: _______________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
__________________________________________________________________
13(a). Other than the case described in question 12, have you filed any further petitions,
applications, or motions with respect to this conviction or sentence in any court, state or federal?
Yes
No
(b) If your answer is "yes," provide the following information:
(1) Name of court: _______________________________________________________
(2) Case number: ________________________________________________________
(3) Result: ______________________________________________________________
(4) Date of result or citation of opinion: ______________________________________
(5) Grounds raised: _______________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
__________________________________________________________________
(c) Did you receive an evidentiary hearing on your petition, application, or motion?
Yes
No
(d) Did you appeal the decision on your petition, application, or motion?
Yes
No
(e) If your answer is "yes," provide the following information:
(1) Name of court: _______________________________________________________
(2) Case number: _________________________________________________________
(3) Result: ______________________________________________________________
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(4) Date of result or citation of opinion: ______________________________________
(5) Grounds raised: _______________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_____________________________________________________________________
14(a). Do you have any petition, appeal, or motion now pending in any court, state or federal,
relating to the judgment being challenged:
Yes
No
(b) If your answer is "yes," provide the following information:
(1) Name of court: _______________________________________________________
(2) Case number: _________________________________________________________
(3) Nature of proceeding: __________________________________________________
______________________________________________________________________________
III. GROUNDS FOR RELIEF
NOTICE TO THE PETITIONER: YOU MAY BE BARRED FROM PRESENTING
ADDITIONAL GROUNDS IN A FUTURE POST-CONVICTION PETITION IF YOU FAIL TO
PRESENT ANY GROUNDS THAT YOU COULD PRESENT HERE BUT DO NOT.
THE FOLLOWING IS A LIST OF THE MOST FREQUENTLY RAISED GROUNDS FOR
RELIEF IN POST-CONVICTION PROCEEDINGS. EACH STATEMENT PRECEDED BY A
LETTER CONSTITUTES A SEPARATE GROUND FOR POSSIBLE RELIEF. YOU SHOULD
RAISE IN THIS PETITION ANY OF THESE GROUNDS THAT APPLY AND ANY OTHER
GROUNDS NOT LISTED THAT YOU MAY HAVE AVAILABLE.
DO NOT MERELY CHECK THE GROUNDS LISTED. IF YOU BELIEVE ANY OF THESE
GROUNDS APPLY TO YOU, YOU MUST ALLEGE FACTS. THE PETITION WILL BE
RETURNED TO YOU IF YOU MERELY CHECK A GROUND AND FAIL TO LIST
NECESSARY FACTS OR ATTACH SUPPORTING DOCUMENTATION.
(a) Conviction obtained by plea of guilty that was unlawfully induced or not made voluntarily
with understanding of the nature of the charge and the consequences of the plea.
(b) Conviction obtained by use of coerced confession.
(c) Conviction obtained by use of evidence gained pursuant to an unconstitutional search and
seizure.
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Person Completing Form:
Address:
Telephone Number:
Bar Number:
(d) Conviction obtained by use of evidence obtained pursuant to an unlawful arrest.
(e) Conviction obtained by a violation of the privilege against self-incrimination.
(f) Conviction obtained by the unconstitutional failure of the prosecution to disclose to the
defendant evidence favorable to the defendant.
(g) Conviction obtained by a violation of the protection against double jeopardy.
(h) Conviction obtained by action of a grand or petit jury that was unconstitutionally selected
and impaneled.
(i) Denial of effective assistance of counsel.
(j) Conviction under an unconstitutional statute or constitutionally protected conduct.
(k) Denial of right to appeal.
15. State concisely every ground on which you claim you are entitled to post-conviction relief.
Summarize briefly the facts supporting each ground. If necessary, you may attach additional pages
stating additional grounds and facts supporting same.
(a) GROUND ONE: _________________________________________________________
SUPPORTING FACTS FOR GROUND ONE (state briefly without citing law or making argument):
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_____________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_____________________________________________________________________
(b) GROUND TWO: ________________________________________________________
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SUPPORTING FACTS FOR GROUND TWO (state briefly without citing law or making argument):
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_____________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_____________________________________________________________________
(c) GROUND THREE: _______________________________________________________
SUPPORTING FACTS FOR GROUND THREE (state briefly without citing law or making
argument):
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_____________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_____________________________________________________________________
(d) GROUND FOUR: _______________________________________________________
SUPPORTING FACTS FOR GROUND FOUR (state briefly without citing law or making
argument):
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_____________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_____________________________________________________________________
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Person Completing Form:
Address:
Telephone Number:
Bar Number:
16. If any of the grounds listed above were not previously presented in any other court, state or
federal, state briefly which grounds were not presented and your reasons for not presenting them:
_______________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_____________________________________________________________________
17. Give the name and address, if known, of each attorney who represented you in the following
stages of the judgment being challenged.
(a) Preliminary hearing: ___________________________________________________
(b) Arraignment and plea: _________________________________________________
(c) Trial: _______________________________________________________________
(d) Sentencing: __________________________________________________________
(e) Appeal: _____________________________________________________________
(f) Post-conviction proceeding: _____________________________________________
(g) Appeal from post-conviction proceeding: __________________________________
18(a). Do you have any future sentence to serve after you complete the sentence imposed by the
judgment being challenged?
Yes
No
(b) If your answer is "yes" give the following information:
(1) Name of court: ________________________________
(2) Location: _____________________________________
(3) Case number: _________________________________
IV. REQUIRED ATTACHMENTS
NOTICE TO THE PETITIONER: IF YOU DO NOT ATTACH THE REQUIRED COPIES OR
PROVIDE AN EXPLANATION WHY YOU CANNOT PROVIDE THEM, THIS PETITION
WILL NOT BE FILED AND WILL BE RETURNED TO YOU. YOU MAY THEN LOSE YOUR
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RIGHT TO FILE A PETITION IF THE STATUTE OF LIMITATIONS EXPIRES BEFORE YOU
FILE ANOTHER PETITION.
19. Attach a copy of the following documents to this petition or provide an explanation why you
cannot provide the copies.
(a) The judgment and commitment being challenged.
(b) Any decision issued by an appellate court from the direct appeal.
(c) Any previously-filed petition for post-conviction relief, and any decision issued as a result.
(d) Affidavits, records, or other documentary evidence that support your claim.
(e) An affidavit of impecuniosity and certificate from the Inmate Accounting Office, if you are
requesting a waiver of the filing fee.
(f) Memorandum of Points and Authorities.
V. PETITIONER’S VERIFICATION UNDER OATH
STATE OF UTAH
COUNTY OF ________________
}ss.
I, the undersigned petitioner, declare under penalty of perjury that the information I have provided
in this petition is true and correct.
______________________________________________
SIGNATURE OF PETITIONER
Subscribed and sworn to before me on: _________________
_______________________________________________
NOTARY PUBLIC
Residing in: _____________________________________
My Commission Expires: __________________________
VI. CERTIFICATION OF ATTORNEY (If petitioner is represented by attorney)
I certify I am the attorney for petitioner, and that this petition complies with Rule 11, Utah Rules of
Civil Procedure.
_______________________________________________
SIGNATURE OF ATTORNEY
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Person Completing Form:
Address:
Telephone Number:
Bar Number:
Name of Petitioner: ______________________________
Address: _______________________________________
_______________________________________________
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