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AMENDMENT TO THE F EDER AL
RULES OF CRIMINAL PR OCEDURE
R u l e 3 5. C o r r e c t i n g or R e d u c in g a S en t e n c e
* * * * *
(c ) “Sen t en c ing” Defined . As used in this rule,
“sentencing” means the oral announcement of the
sentence.
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RULES GOVERNING SECTION 2254 CASESIN THE UNITE D STATES DISTRICT COURTS
Ru le 1 . Scop e
(a ) Cases Invo lv ing a Pe t i t ion under 28 U.S .C .
§ 2254. These rules govern a petition for a writ of
habeas corpus filed in a United States district court
un der 28 U .S.C. § 2254 by:
(1) a person in custody un der a stat e-cour t judgment
who seeks a determination that the custody
violates the Constitution, laws, or treaties of the
United States; an d
(2) a person in custody under a state-court or
federal-court judgment who seeks a
determination t hat futu re custody under a s ta te-
court judgment would violate the Constitution,
laws, or t reat ies of th e United St at es.
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2 RULE S GOVERN ING § 2254 CASES
(b ) Oth er Cases . The district court may apply any or
all of these rules to a habeas corpus petition not
covered by Ru le 1(a).
Ru le 2 . The Pe t i t ion
(a ) C u r r e n t C u s t od y ; N a m i n g t h e R e s p o n d e n t . I f
the petitioner is currently in custody under a state-
court judgment, the petition must name as
responden t t he st at e officer who ha s cust ody.
(b ) F u t u r e C u s t o d y ; N a m i n g t h e R e s p o n d e n t s a n d
S p e c ify in g t h e J u d g m e n t . If the petitioner is not
yet in custody — but ma y be subject t o fut ur e cust ody
— under the state-court judgment being contested,
the peti t ion must name as respondents both the
officer who has current custody and the attorney
general of th e stat e where the judgment was ent ered.
The petition must ask for relief from the state-court
judgment being contested.
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RULES GOVERNIN G § 2254 CASES 3
(c ) Form. The petition must:
(1) specify all th e groun ds for r elief available to th e
petitioner;
(2) stat e th e facts supporting each ground;
(3) stat e the r elief requested;
(4) be printed, typewritten, or legibly handwritten;
and
(5) be signed under penalty of perjury by the
petitioner or by a per son au th orized to sign it for
th e petitioner u nd er 28 U.S.C. § 2242.
( d ) S t a n d a r d F o r m . The petition must substantially
follow either the form appended to these rules or a
form prescribed by a local district-court rule. The
clerk must make forms available to petitioners
without charge.
(e ) S e p a r a t e P e t i t io n s fo r J u d g m e n t s o f S e p a r a t e
C o u r t s . A petitioner who seeks relief from
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4 RULE S GOVERN ING § 2254 CASES
judgments of more than one state court must file a
separa te petition covering th e judgment or judgment s
of each cour t.
Ru le 3 . F i l ing th e P e t i t ion ; Inm at e F i l in g
(a) Where to Fi le ; Copies ; Fi l ing Fee. An original
and two copies of the petition must be filed with the
clerk an d mu st be a ccompa nied by:
(1) th e a pplicab le filing fee, or
(2) a m otion for lea ve to proceed in form a pau peris,
th e affidavit requ ired by 28 U.S.C. § 1915, an d a
certificate from the warden or other appropriate
officer of the place of confinement showing the
am ount of money or securities tha t th e petitioner
has in an y accoun t in t he inst i tut ion.
(b ) F i l ing . The clerk m ust file th e petition a nd en ter it
on t he docket.
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RULES GOVERNIN G § 2254 CASES 5
(c) Tim e to Fi le . The time for filing a petition is
govern ed by 28 U .S.C. § 2244(d).
(d ) I n m a t e F i li n g . A pa per filed by an inm at e confined
in an institution is timely if deposited in the
instit ut ion’s inter na l ma iling system on or before th e
last day for filing. If an inst itu tion ha s a system
designed for legal mail, the inmate must use that
system t o receive th e benefit of th is ru le. Timely
filing may be shown by a declaration in compliance
with 28 U.S.C. § 1746 or by a notarized statement,
either of which mu st set fort h t he da te of deposit a nd
stat e tha t first-class postage ha s been prepaid.
Ru le 4. P r e l i m i n a r y R e v ie w; S e r v i n g t h e P e t i t i on
a n d O r d e r
The clerk must promptly forward the petition to a
judge under th e cour t’s a ssignm ent procedure, a nd th e
judge mu st promptly examin e it. If it plainly ap pear s
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6 RULE S GOVERN ING § 2254 CASES
from the petition and any attached exhibits that the
petitioner is not entitled to relief in the district court, the
judge must dismiss the petition and direct the clerk to
notify th e petitioner . If th e petition is not dismissed, th e
judge must order the respondent to file an answer,
motion, or other response within a fixed time, or to take
oth er a ction th e judge may order. In every case, th e clerk
must serve a copy of the petition and any order on the
respondent and on the attorney general or other
ap pr opriat e officer of th e sta te involved.
R u l e 5. T h e An s w e r a n d t h e R e p l y
(a ) Wh e n R e q u i r e d . The respondent is not r equired to
an swer th e petition u nless a judge so orders.
(b ) C o n t e n t s : Ad d r e s s i n g t h e All e g a t i o n s ; S t a t i n g a
B a r . The an swer m ust a ddress the al legations in t he
petition. In addition, it mu st stat e wheth er an y
claim in th e petition is barred by a failure to exhaust
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RULES GOVERNIN G § 2254 CASES 7
sta te r emedies, a procedur al bar , non-ret roactivity, or
a st at ut e of limitat ions.
(c ) C o n t e n t s : T r a n s c r i p t s . The answer must also
indicate what transcripts (of pretrial, trial,
sentencing, or post-conviction proceedings) are
available, when they can be furnished, and what
proceedings h ave been recorded bu t not t ra nscribed.
The respondent must at tach to the answer parts of
th e tran script tha t th e respondent considers relevant.
The judge may order that the respondent furnish
other parts of existing transcripts or that parts of
untranscribed recordings be transcribed and
furn ished. If a tra nscript can not be obtained, th e
respondent may submit a narrative summary of the
evidence.
( d ) C o n t e n t s : B r i e fs o n Ap p e a l a n d Op in i o n s . The
responden t m ust also file with t he a nswer a copy of:
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8 RULE S GOVERN ING § 2254 CASES
(1) any brief that the petitioner submitted in an
appellate court contesting the conviction or
sentence, or contesting an adverse judgment or
order in a post-conviction pr oceeding;
(2) any brief that the prosecution submitted in an
appellate court relating to the conviction or
senten ce; an d
(3) the opinions and dispositive orders of the
appellate court relating to the conviction or the
sentence.
(e) Reply . The petitioner may submit a reply to the
responden t’s an swer or other plead ing with in a tim e
fixed by the judge.
Ru le 6 . Discover y (a ) L e a v e o f C o u r t R e q u i r e d . A judge may, for good
cause, authorize a party to conduct discovery under
the Federal Rules of Civil Procedure and may limit
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RULES GOVERNIN G § 2254 CASES 9
th e exten t of discovery. If necessa ry for effective
discovery, the judge must appoint an attorney for a
petitioner who qualifies to have counsel appointed
un der 18 U.S.C. § 3006A.
(b ) Req ue s t in g Discover y . A party requesting
discovery mu st provide reasons for th e request. The
request must also include any proposed
interrogatories an d requests for a dmission, an d mu st
specify an y request ed docum ent s.
(c ) Depos i t ion Expe n ses . If th e respondent is gra nt ed
leave to ta ke a deposition, th e judge ma y require th e
respondent to pay the travel expenses, subsistence
expenses, an d fees of th e petitioner’s at torn ey to
at ten d the deposition.
R u l e 7 . E x p a n d i n g t h e R e c o r d
(a ) I n Ge n e r a l . If the petition is not dismissed, the
judge may direct t he pa rt ies to expand t he r ecord by
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10 RULE S GOVERN ING § 2254 CASES
submitting additional materials relating to the
petition. The judge may require that these materials
be au then ticat ed.
(b ) Types o f Mate r ia l s . The materials that may be
required include letters predating the filing of the
petition, documents, exhibits, and answers under
oath to written interrogatories propounded by the
judge. Affidavits ma y also be subm itted an d
consider ed as pa rt of th e record.
(c ) R e v i e w b y t h e Op p o s i n g P a r t y . The judge must
give the part y against whom the a dditiona l materials
are offered an opportunity to admit or deny their
correctness.
R u l e 8 . E v i d e n t i a r y He a r i n g (a ) De t e r m i n i n g Wh e t h e r t o Ho l d a He a r i n g . If the
petition is not dismissed, the judge must review the
answer, any transcripts and records of state-court
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RULE S GOVERN ING § 2254 CASES 11
proceedings, and an y mat erials submitted un der Rule
7 to determine whether an evidentiary hearing is
warranted.
(b ) R e fe r e n c e t o a Ma g i s t r a t e J u d g e . A judge may,
under 28 U.S.C. § 636(b), refer the petition to a
magistrate judge to conduct hearings and to file
proposed findings of fact and recommendations for
disposition. When they are filed, th e clerk must
promptly serve copies of the proposed findings and
recomm enda tions on all par ties. With in 10 days
after being served, a party may file objections as
provided by local cour t rule. The judge mu st
determine de novo any proposed finding or
recomm enda tion to which objection is ma de. The
judge may accept, reject, or modify any proposed
finding or recomm enda tion.
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12 RULE S GOVERN ING § 2254 CASES
(c ) Appoin t ing Counse l ; T ime of Hear ing . If an
evidentiary hearing is warranted, the judge must
appoint an attorney to represent a petitioner who
qualifies to have counsel appointed under 18 U.S.C.
§ 3006A. The judge must cond uct th e hear ing as soon
as practicable after giving the attorneys adequate
time to investigate and prepare. These rules do not
limit the appointment of counsel under § 3006A at
an y sta ge of th e proceeding.
Ru le 9 . Second o r Success ive P e t i t ions
Before presen ting a second or successive pet ition, t he
petitioner must obtain an order from the appropriate
court of appeals authorizing the district court to consider
th e pet ition a s requ ired by 28 U.S.C. § 2244(b)(3) an d (4).
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RULE S GOVERN ING § 2254 CASES 13
R u l e 10 . P o we r s o f a Ma g is t r a t e J u d g e
A magistrate judge may perform the duties of a
district judge under these rules, as authorized under
28 U .S.C. § 636.
Ru le 11. App l icab i l i ty o f th e Fe der a l Ru les o f C ivi l
P r o c e d u r e
The Federal Rules of Civil Procedure, to the extent
that they are not inconsistent with any statutory
provisions or these rules, may be applied to a proceeding
un der these rules.
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RULES GOVERNING SECTION 2255 CASESIN THE UNITE D STATES DISTRICT COURTS
Ru le 1 . Scop e
These ru les govern a motion filed in a United St at es
distr ict cour t u nd er 28 U .S.C. § 2255 by:
(a ) a person in custody under a judgment of that court
who seeks a determinat ion th at:
(1) th e judgm ent violates t he Constitu tion or laws of
the United States;
(2) the court lacked jurisdiction to enter the
judgment;
(3) th e senten ce exceeded the m aximum allowed by
law; or
(4) the judgment or sentence is otherwise subject to
collateral review; and
(b ) a person in custody un der a judgmen t of a st at e cour t
or another federal court, and subject to future
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2 RULE S GOVERN ING § 2255 CASES
custody under a judgment of the district court, who
seeks a determinat ion t hat :
(1) future custody under a judgment of the district
court would violate the Constitution or laws of
the United States;
(2) the district court lacked jurisdiction to enter the
judgment;
(3) th e distr ict court ’s sen ten ce exceeded t he
ma ximum allowed by law; or
(4) th e district cour t’s judgmen t or sen ten ce is
other wise subject t o collater al r eview.
Ru le 2 . The Mot ion (a) App lying for Rel ief . The applicat ion m ust be in t he
form of a motion to vacate, set aside, or correct the
sentence.
(b ) Form. The motion must :
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RULES GOVERNIN G § 2255 CASES 3
(1) specify all th e groun ds for r elief available to th e
moving par ty;
(2) stat e th e facts supporting each ground;
(3) stat e the r elief requested;
(4) be printed, typewritten, or legibly handwritten;
and
(5) be signed under penalty of perjury by the
movant or by a person authorized to sign it for
the movan t.
(c ) St a n d a r d F o r m . The motion must substantially
follow either the form appended to these rules or a
form pr escribed by a local district-cour t ru le. The
clerk must make forms available to moving parties
without charge.
(d ) S e p a r a t e M o t io n s fo r S e p a r a t e J u d g m e n t s . A
moving party who seeks relief from more than one
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4 RULE S GOVERN ING § 2255 CASES
judgment must file a separate motion covering each
judgment.
Ru le 3 . F i l ing th e Mot ion ; Inm at e F i ling
(a ) Where to Fi le ; Copies . An original and two copies
of the m otion mu st be filed with th e clerk.
(b ) F i li n g a n d S e r v ic e . The clerk must file the motion
and enter it on the criminal docket of the case in
which the cha llenged judgment was enter ed. The
clerk mu st t hen deliver or ser ve a copy of the m otion
on the United States attorney in that district,
togeth er wit h a notice of its filing.
(c ) T i m e t o F i l e . The time for filing a motion is
govern ed by 28 U .S.C. § 2255 pa ra . 6.
(d ) I n m a t e F i l in g . A paper filed by an inmate confined
in an institution is timely if deposited in the
instit ut ion’s inter na l ma iling system on or before th e
last day for filing. If an inst itu tion ha s a system
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RULES GOVERNIN G § 2255 CASES 5
designed for legal mail, the inmate must use that
system t o receive th e benefit of th is ru le. Timely
filing may be shown by a declaration in compliance
with 28 U.S.C. § 1746 or by a notarized statement,
either of which mu st set fort h t he da te of deposit a nd
stat e tha t first-class postage ha s been prepaid.
R u l e 4 . P r e l i m i n a r y R e v i ew
(a ) R e f e r r a l t o a J u d g e . The clerk must promptly
forward the motion to the judge who conducted the
trial and imposed sentence or, if the judge who
imposed senten ce was n ot t he t rial judge, to the judge
who conducted the proceedings being challenged. If
th e appr opriate judge is not available, the clerk mu st
forward th e motion t o a judge un der t he cour t’s
assignment procedure.
(b ) I n i t ia l C on s i d e r a t i o n b y t h e J u d g e . The judge
who receives the motion must promptly examine it.
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6 RULE S GOVERN ING § 2255 CASES
If it plainly appears from the motion, any attached
exhibits, and the record of prior proceedings that the
moving party is not entitled to relief, the judge must
dismiss the motion and direct the clerk to notify the
moving part y. If th e motion is not dismissed, th e
judge must order the United States attorney to file
an answer, motion, or other response within a fixed
time, or t o take other a ction t he judge may order.
R u l e 5. T h e An s w e r a n d t h e R e p l y
(a ) Wh e n R e q u i r e d . The respondent is not r equired to
an swer th e motion u nless a judge so orders.
(b ) C o n t e n t s . The an swer must address the al legations
in the motion. In addition, it must sta te whether th e
moving party has used any other federal remedies,
including any prior post-conviction motions under
these rules or any previous rules, and whether the
moving part y received an evidentiar y hear ing.
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RULES GOVERNIN G § 2255 CASES 7
( c ) R e c o r d s o f P r i o r P r o c e e d i n g s . If the answer
refers to briefs or t ra nscripts of the pr ior p roceedings
th at ar e not a vailable in th e cour t’s records, th e judge
must order the government to furnish them within a
reasonable time that will not unduly delay the
proceedings.
( d ) R e p l y . The moving part y may submit a r eply to the
responden t’s an swer or other plead ing with in a tim e
fixed by the judge.
Ru le 6 . Discover y
(a ) L e a v e of Co u r t R e q u i r e d . A judge may, for good
cause, authorize a party to conduct discovery under
the Federal Rules of Criminal Procedure or Civil
Procedure, or in accordance with the practices and
pr inciples of law. If necessar y for effective discovery,
the judge must appoint an attorney for a moving
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8 RULE S GOVERN ING § 2255 CASES
party who qualifies to have counsel appointed under
18 U .S.C. § 3006A.
(b ) Req ue s t in g Discover y . A party requesting
discovery must provide reasons for the request. The
request must also include any proposed
interr ogatories an d r equests for a dmission, a nd must
specify an y request ed docum ent s.
(c ) Depos i t ion Expe n ses . If th e governmen t is grant ed
leave to ta ke a deposition, th e judge ma y require th e
government to pay the travel expenses, subsistence
expenses, an d fees of th e moving pa rt y’s at torn ey to
at ten d the deposition.
R u l e 7 . E x p a n d i n g t h e R e c o r d
(a ) I n G e n e r a l . If the motion is not dismissed, the
judge may direct t he pa rt ies to expand t he r ecord by
submitting additional materials relating to the
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RULES GOVERNIN G § 2255 CASES 9
motion. The judge may require that these materials
be au then ticat ed.
(b ) Types o f Mate r ia l s . The materials that may be
required include letters predating the filing of the
motion, docum ents, exhibits, an d a nswers u nder oat h
to written interrogatories propounded by the judge.
Affidavits also may be submitted and considered as
par t of th e record.
(c ) R e v i e w b y t h e Op p o s i n g P a r t y . The judge must
give the part y against whom the a dditiona l materials
are offered an opportunity to admit or deny their
correctness.
R u l e 8 . E v i d e n t i a r y He a r i n g
(a ) D e t e r m i n i n g Wh e t h e r t o H o l d a H e a r i n g . If the
motion is not dismissed, the judge must review the
answer, any transcripts and records of prior
proceedings, and an y mat erials submitted un der Rule
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10 RULE S GOVERN ING § 2255 CASES
7 to determine whether an evidentiary hearing is
warranted.
(b ) R e fe r e n c e t o a Ma g i s t r a t e J u d g e . A judge may,
under 28 U.S.C. § 636(b), refer the motion to a
magistrate judge to conduct hearings and to file
proposed findings of fact and recommendations for
disposition. When they are filed, th e clerk must
promptly serve copies of the proposed findings and
recomm enda tions on all par ties. With in 10 days
after being served, a party may file objections as
provided by local cour t rule. The judge mu st
determine de novo any proposed finding or
recommendation to which objection is made. The
judge may accept, reject, or modify any proposed
finding or recomm enda tion.
(c ) Appoin t ing Counse l ; T ime of Hear ing . If an
evidentiary hearing is warranted, the judge must
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RULE S GOVERN ING § 2255 CASES 11
appoint an at torney to represent a moving party who
qualifies to have counsel appointed under 18 U.S.C.
§ 3006A. The judge must cond uct th e hear ing as soon
as practicable after giving the attorneys adequate
time to investigate and prepare. These rules do not
limit the appointment of counsel under § 3006A at
an y sta ge of th e proceeding.
(d ) P r o d u c i n g a S t a t e m e n t . Federal Rule of Criminal
Procedure 26.2(a)-(d) and (f) applies at a hearing
un der th is ru le. If a pa rt y does not comply with a
Rule 26.2(a) order to produce a witness’s statement,
th e cour t m ust not consider th at witn ess’s test imony.
Ru le 9 . Second o r Success ive Mot ions
Before presen ting a second or su ccessive m otion, t he
moving party must obtain an order from the appropriate
court of appeals authorizing the district court to consider
th e motion, as requ ired by 28 U.S.C. § 2255, pa ra . 8.
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12 RULE S GOVERN ING § 2255 CASES
R u l e 10 . P o we r s o f a Ma g is t r a t e J u d g e
A magistrate judge may perform the duties of a
district judge under these rules, as authorized by 28
U.S.C. § 636.
Ru le 11. Time to App ea l
Feder al Ru le of Appellate P rocedur e 4(a) govern s th e
time to appeal an order entered un der these rules. These
rules do not extend the time to appeal the original
jud gmen t of conviction.
Ru le 12. App l icab i l i ty o f th e Fe der a l Ru les o f C ivi l
P r o ce d u r e a n d t h e F e d e r a l R u l e s o f
C r i m in a l P r o c e d u r e
The F ederal Rules of Civil Pr ocedure an d th e Federa l
Rules of Criminal Procedure, to the extent that they are
not inconsistent with any statutory provisions or these
ru les, may be a pplied to a proceeding u nder th ese rules.
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Page 1
P e t i t i o n fo r R e l i e f F r o m a C o n v ic t i on o r S e n t e n c e
B y a P e r s o n i n S t a t e C u s t o d y
(Pe t i t i on U n der 28 U .S .C . § 2254 fo r a Wr i t o f H abea s C orp us )
I n s t r u c t i o n s
1. To use this form, you must be a person who is curr ently serving a sentence under a judgment
again st you in a sta te cour t. You are askin g for relief from th e conviction or th e senten ce. This
form is your petition for relief.
2. You may a lso use th is form to challenge a st ate judgment tha t imposed a sent ence to be served in
the futur e, but you must fill in th e nam e of the state where th e judgment was ent ered. If you
want to challenge a federal judgment t hat imposed a sent ence to be served in t he futur e, you
should file a motion u nder 28 U .S.C. § 2255 in t he federal court tha t en tered t he judgment.
3. Make sure the form is typed or neatly writt en.
4. You m ust tell the tru th and sign t he form. If you m ake a false stat ement of a m aterial fact, you
may be prosecuted for perjury.
5. Answer all the quest ions. You do not need to cite law. You may submit a dditional pages if
necessary. If you do not fill out t he form properly, you will be asked to submit additional or
correct informa tion. If you wan t to submit a brief or a rgument s, you must su bmit th em in a
separate memorandu m.
6. You mu st pa y a fee of $5. If the fee is paid, your pet ition will be filed. If you can not pa y the fee,
you m ay as k to proceed in form a pauperis (as a poor pers on). To do that , you must fill out th e
last pa ge of this form . Also, you m ust subm it a certificat e signed by an officer at t he inst itut ion
where you are confined showing the a mount of money tha t th e institu tion is holding for you. If
your account exceeds $ , you mu st pay the filing fee.
7. In th is petition, you ma y cha llenge th e judgmen t ent ered by only one court. If you wan t to
challenge a judgment entered by a different court (either in th e same stat e or in different stat es),
you must file a separ ate petition.
8. When you ha ve completed th e form, send th e original an d two copies to the Clerk of th e Un ited
Stat es District Court at t his address:
Clerk, United States District Court for AddressCity, Sta te Zip Code
9. C AU T IO N : Yo u m u s t i n c l u d e i n t h i s p e t i t i o n a l l t h e g r o u n d s f or r e l ie f fr o m t h e
c o n v ic t i on o r s e n t e n c e t h a t y o u c h a l le n g e . An d y o u m u s t s t a t e t h e fa c t s t h a t s u p p o r te a c h g r o u n d . I f y o u fa i l t o s e t fo r t h a l l t h e g r o u n d s in t h i s p e t i t i o n , y o u m a y b e b a r r e d
fr o m p r e s e n t i n g a d d i t io n a l g r o u n d s a t a l a t e r d a t e .
10. C AP I T AL C AS E S : I f y o u a r e u n d e r a s e n t e n c e o f d e a t h , y o u a r e e n t i t l e d t o t h e
a s s is t a n c e o f co u n s e l a n d s h o u l d r e q u e s t t h e a p p o i n t m e n t o f c o u n s e l.
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P ETI TION UNDE R 28 U.S.C . § 2254 FOR WRIT OF
HABEAS CORP US BY A P ER SON IN STATE CUSTODY
U n i t e d S t a t e s D i s t r i c t Co u r t District
Name (under which you were convicted): Docket or Case No.:
Place of Confinement : Prisoner No.:
Petitioner (include the name under which you were convicted) Respondent (authorized person h aving custody of petitioner)
v.
The Attorney General of the State of
P E T I T I O N
1. (a) Na me an d location of cour t th at en ter ed the judgment of conviction you ar e cha llenging:
(b) Criminal docket or case number (if you know):
2. (a) Da te of th e judgm ent of conviction (if you kn ow):
(b) Dat e of senten cing:
3. Lengt h of sent ence:
4. In t his case, were you convicted on more th an one coun t or of more th an one crime? Yes “ No “ 5. Ident ify all crimes of which you were convicted and sent enced in th is case:
6. (a) What was your plea? (Check one)
(1) Not guilt y “ (3) Nolo cont end er e (no cont est ) “ (2) Guilty
“ (4) Insa nity plea
“ (b) If you en ter ed a guilty plea t o one coun t or char ge and a n ot guilty plea t o another coun t or
charge, what did you plead guilty to and wh at did you plead n ot guilty to?
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(c) If you wen t t o trial, wha t k ind of trial did you ha ve? (Check one)
J u r y “ Judge only “ 7. Did you t estify at a pr etrial hear ing, trial, or a post-trial hearing?
Yes “ No “ 8. Did you a ppeal from t he judgm ent of conviction?
Yes “ No “ 9. If you did appea l, answer th e following:
(a) Name of court:
(b) Docket or case number (if you know):
(c) Result:
(d) Dat e of res ult (if you kn ow):
(e) Citation to the case (if you know):
(f) Grounds r aised:
(g) Did you seek furt her review by a higher sta te court ? Yes “ No “ If yes, answer the following:
(1) Name of court:
(2) Docket or case number (if you know):
(3) Result :
(4) Dat e of resu lt (if you kn ow):
(5) Citation to the case (if you know):
(6) Grounds raised:
(h) Did you file a petit ion for certiorari in th e Un ited Sta tes Supr eme Court? Yes “ No “ If yes, answer the following:
(1) Docket or case number (if you know):
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12. For t his pet ition, sta te every groun d on wh ich you claim t ha t you ar e being held in violation of
the Constitut ion, laws, or t reat ies of the Un ited States. Attach additional pages if you h ave more
tha n four grounds. Stat e the facts supporting each ground.
CAUTION: To proceed in th e federa l court , you m ust ordinar ily first exhau st (use up ) your
available state-court remedies on each ground on which you request action by the federal court.
Also, if you fail to set fort h a ll the groun ds in t his pet ition, you may be bar red from presen ting
additional grounds at a later dat e.
GROUND ONE:
(a) Support ing facts (Do not ar gue or cite law. J ust sta te th e specific facts t ha t su pport your claim.):
(b) If you did not exhau st your st at e remedies on Groun d One, explain why:
(c) D i r e c t Ap p e a l o f G r o u n d O n e :
(1) If you appea led from th e judgmen t of conviction, did you r aise t his issue?
Yes “ No “ (2) If you did n ot raise t his issu e in your direct a ppeal, explain why:
(d) P o s t -C o n v i c t i on P r o c e e d i n g s :
(1) Did you r aise th is issue th rough a post-conviction motion or pet ition for habea s corpu s in a
sta te tr ial cour t? Yes “ No “ (2) If your an swer to Ques tion (d)(1) is “Yes,” st at e:
Type of motion or petition:
Na me an d location of the cour t wher e th e motion or petit ion was filed:
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Docket or case n um ber (if you k now):
Date of the court’s decision:
Result (attach a copy of the court’s opinion or order, if available):
(3) Did you r eceive a hea ring on your motion or petition?
Yes “ No “ (4) Did you a pp eal from th e denia l of your motion or petit ion?
Yes “ No “ (5) If your an swer t o Question (d)(4) is “Yes,” did you ra ise th is issue in th e ap peal?
Yes “ No “ (6) If your an swer to Ques tion (d)(4) is “Yes,” st at e:
Name and location of the court where the appeal was filed:
Docket or case n um ber (if you k now):
Date of the court’s decision:
Result (attach a copy of the court’s opinion or order, if available):
(7) If your answer to Question (d)(4) or Question (d)(5) is “No,” explain why you did not raise this
issue:
(e) O t h e r R e m e d i e s: Describe any other procedures (such as habeas corpus, a dministra tive
remedies, etc.) that you h ave used to exhaust your stat e remedies on Ground On e:
GROUND T WO:
(a) Support ing facts (Do not ar gue or cite law. J ust sta te th e specific facts t ha t su pport your claim.):
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(b) If you did not exha ust your sta te r emedies on Ground Two, explain wh y:
(c) D i r e c t Ap p e a l o f G r o u n d T w o :
(1) If you appea led from th e judgment of conviction, did you r aise t his issu e?
Yes “ No “ (2) If you did n ot raise t his issu e in your direct a ppeal, explain why:
(d) P o s t -C o n v i c t i on P r o c e e d i n g s :
(1) Did you r aise t his issu e th rough a post-conviction motion or petition for h abeas corpu s in a
stat e trial court ?
Yes “ No “ (2) If your an swer to Ques tion (d)(1) is “Yes,” st at e:
Type of motion or petition:
Na me a nd locat ion of th e court wh ere t he motion or petit ion wa s filed:
Docket or case n um ber (if you k now):
Date of the court’s decision:
Result (attach a copy of the court’s opinion or order, if available):
(3) Did you receive a hea ring on your motion or petition?
Yes “ No “ (4) Did you a ppeal from t he den ial of your motion or petition?
Yes “ No “ (5) If your an swer t o Question (d)(4) is “Yes,” did you ra ise th is issue in th e ap peal?
Yes “ No “ (6) If your an swer to Ques tion (d)(4) is “Yes,” st at e:
Name and location of the court where the appeal was filed:
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Docket or case n um ber (if you k now):
Date of the court’s decision:
Result (attach a copy of the court’s opinion or order, if available):
(7) If your answer to Question (d)(4) or Question (d)(5) is “No,” explain why you did not raise this
issue:
(e) O t h e r R e m e d i e s: Describe any other procedures (such as h abeas corpu s, administr ative
remedies, etc.) that you h ave used to exhaust your stat e remedies on Gr oun d Two:
G R O U ND TH R EE :
(a) Support ing facts (Do not ar gue or cite law. J ust sta te th e specific facts t ha t su pport your claim.):
(b) If you did not exhaust your state remedies on Ground Three, explain why:
(c) D ir e c t A p p e a l o f G r o u n d T h r e e :
(1) If you appea led from th e judgment of conviction, did you r aise t his issu e?
Yes “ No “ (2) If you did n ot raise t his issu e in your direct a ppeal, explain why:
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(d) P o s t -C o n v i c t i on P r o c e e d i n g s :
(1) Did you r aise t his issu e th rough a post-conviction motion or petition for h abeas corpu s in a
sta te tr ial cour t? Yes “ No “ (2) If your an swer to Ques tion (d)(1) is “Yes,” st at e:
Type of motion or petition:
Na me and location of the cour t wh ere th e motion or pet ition was filed:
Docket or case n um ber (if you k now):
Date of the court’s decision:
Result (attach a copy of the court’s opinion or order, if available):
(3) Did you r eceive a hea ring on your motion or petition?
Yes “ No “ (4) Did you a ppeal from t he den ial of your motion or petition?
Yes “ No “ (5) If your an swer t o Question (d)(4) is “Yes,” did you ra ise th is issue in th e ap peal?
Yes “ No “ (6) If your an swer to Ques tion (d)(4) is “Yes,” st at e:
Name and location of the court where the appeal was filed:
Docket or case n um ber (if you k now):
Date of the court’s decision:
Result (attach a copy of the court’s opinion or order, if available):
(7) If your answer to Question (d)(4) or Question (d)(5) is “No,” explain why you did not raise this
issue:
(e) O t h e r R e m e d i e s: Describe any other procedures (such as h abeas corpu s, administr ative
remedies, etc.) that you h ave used to exhau st your stat e remedies on Groun d Thr ee:
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G R O U N D FO U R :
(a) Support ing facts (Do not ar gue or cite law. J ust sta te th e specific facts t ha t su pport your claim.):
(b) If you did not exhaust your state remedies on Ground Four, explain why:
(c) D i r e c t Ap p e a l of G r o u n d F o u r :
(1) If you appea led from th e judgment of conviction, did you r aise t his issu e?
Yes “ No “ (2) If you did n ot raise t his issu e in your direct a ppeal, explain why:
(d) P o s t -C o n v i c t i on P r o c e e d i n g s :
(1) Did you r aise t his issu e th rough a post-conviction motion or petition for h abeas corpu s in a
sta te tr ial cour t? Yes “ No “ (2) If your an swer to Ques tion (d)(1) is “Yes,” st at e:
Type of motion or petition:
Na me a nd location of th e court wh ere th e motion or pet ition was filed:
Docket or case n um ber (if you k now):
Date of the court’s decision:
Result (attach a copy of the court’s opinion or order, if available):
(3) Did you r eceive a hea ring on your motion or petition?
Yes “ No “ (4) Did you a ppeal from t he den ial of your motion or petition?
Yes “ No “
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(5) If your an swer t o Question (d)(4) is “Yes,” did you ra ise th is issue in th e ap peal?
Yes “ No “ (6) If your an swer to Ques tion (d)(4) is “Yes,” st at e:
Name and location of the court where the appeal was filed:
Docket or case n um ber (if you k now):
Date of the court’s decision:
Result (attach a copy of the court’s opinion or order, if available):
(7) If your answer to Question (d)(4) or Question (d)(5) is “No,” explain why you did not raise this
issue:
(e) O t h e r R e m e d i e s: Describe any other procedures (such as h abeas corpu s, administr ative
remedies, etc.) that you h ave used to exhau st your stat e remedies on Ground Four:
13. Please an swer th ese additional questions about th e petition you are filing:
(a) Have all grounds for r elief that you h ave raised in t his petition been pr esented to the highest
sta te cour t ha ving jurisdiction? Yes “ No “ If your an swer is “No,” sta te which groun ds ha ve not been so present ed an d give your
reason(s) for n ot presenting t hem:
(b) Is there a ny ground in t his petition t hat has n ot been presented in some state or federal
cour t? If so, which groun d or grounds h ave not been presented, an d stat e your reas ons for
not presenting them:
14. Ha ve you pr eviously filed any t ype of petition, application, or m otion in a federal cour t r egard ing
Yes “ No “the conviction that you challenge in this petition?
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If “Yes,” sta te t he n am e an d locat ion of the cour t, th e docket or case n um ber, th e type of
proceeding, the issues r aised, th e dat e of th e cour t’s decision, an d th e resu lt for ea ch petition,
ap plication, or motion filed. Atta ch a copy of an y court opinion or order , if ava ilable.
15. Do you ha ve any pet ition or a ppeal n ow pending (filed and n ot decided yet) in a ny cour t, either
sta te or federal, for th e judgmen t you ar e challenging? Yes “ No “ If “Yes,” sta te t he n am e an d locat ion of the cour t, th e docket or case n um ber, th e type of
proceeding, and the issues raised.
16. Give the na me an d addr ess, if you kn ow, of each at torney who repr esent ed you in t he following
stages of the judgment you are challenging:
(a) At preliminary hearing:
(b) At a rra ignment and plea:
(c) At t ria l:
(d) At sent encing:
(e) On a ppeal:
(f) In any post-conviction proceeding:
(g) On app eal from an y ru ling again st you in a p ost-conviction pr oceeding:
17. Do you have an y futu re sent ence to serve after you complete th e sentence for the judgment tha t
Yes “ No “you are challenging?
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(a) If so, give na me a nd locat ion of court th at imposed th e other sen ten ce you will serve in th e
future:
(b) Give th e date t he other s ent ence was imposed: (c) Give the length of th e other sent ence: (d) Ha ve you filed, or do you plan to file, any petition th at challenges th e judgment or sent ence tobe served in th e futur e? Yes “ No “
18. TIMELINE SS OF PE TITION: If your judgment of conviction became fina l over one yea r a go, you
mu st explain wh y the one-year sta tu te of limitat ions a s cont ained in 28 U.S.C. § 2244(d) does not
bar your petition.*
* The Antiter rorism a nd Effective Deat h P enalt y Act of 1996 (“AEDPA”) as cont ained in 28 U .S.C.
§ 2244(d) provides in par t t ha t:
(1) A one-year per iod of limitat ion sh all apply to an application for a writ of habeas corpu s by a
person in custody pursu ant to the judgment of a Sta te court . The limitat ion period shall run
from t he lat est of —
(continued…)
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Therefore, petitioner asks tha t the Court grant th e following relief:
or any other relief to which pet itioner ma y be entitled.
Signature of Attorney (if any)
I declar e (or certify, verify, or st at e) under p ena lty of perjur y tha t t he foregoing is tr ue a nd correct
and that this Petition for Writ of Habeas Corpus was placed in the prison mailing system on
(month, date, year).
Execut ed (signed) on (date).
Signature of Petitioner
*(…continued)
(A) the da te on wh ich t he judgm ent becam e fina l by the conclusion of direct review or th e
expiration of th e time for seeking such r eview;
(B) th e dat e on wh ich t he impedim ent to filing an ap plicat ion creat ed by Stat e action in
violation of th e Const itut ion or laws of th e Unit ed Sta tes is rem oved, if th e applicant wa sprevent ed from filing by such st at e action;
(C) the date on which the constitutional right asserted was initially recognized by the
Supreme Court , if the r ight ha s been newly recognized by the Su preme Court a nd m ade
retroactively applicable to cases on collateral review; or
(D) th e dat e on which th e factu al pr edicat e of th e claim or claims pr esent ed could h ave been
discovered through the exercise of due diligence.
(2) The t ime du ring wh ich a properly filed application for S ta te p ost-conviction or other collater al
review with r espect t o the pert inent judgment or claim is pending shall not be count ed toward
any period of limitation under this subsection.
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If the person signing is not petitioner, state relationship to petitioner and explain why petitioner is
not signing this petition.
IN FORMA PAUPERIS DECLARATION
[Insert appropriate court ]
* * * * *
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Mo t io n t o Va c a t e , Se t Asi d e , o r C o r r e c t a S e n t e n c e
B y a P e r s o n i n F e d e r a l C u s t o d y
(Mot ion Un de r 28 U.S.C . § 2255)
I n s t r u c t i o n s
1. To use this form, you m ust be a person who is serving a sentence under a judgment against you
in a federal cour t. You are ask ing for relief from t he conviction or th e senten ce. This form is
your m otion for relief.
2. You must file the form in t he United Sta tes district court tha t ent ered the judgment t hat you ar e
challenging. If you wan t to cha llenge a federal judgm ent t ha t imposed a senten ce to be served in
the futu re, you should file the motion in t he federal court tha t ent ered tha t judgment.
3. Make sure the form is typed or neatly writt en.
4. You must tell the tr uth and sign t he form. If you m ake a false stat ement of a material fact, you
may be prosecuted for perjury.
5. Answer all the questions. You do not need to cite law. You may submit a dditional pages if
necessary. If you do not fill out t he form properly, you will be asked to submit additional or
correct informa tion. If you wan t to submit a brief or a rgument s, you must su bmit th em in a
separate memorandu m.
6. If you can not pa y for t he costs of th is motion (such a s costs for a n at torney or t ra nscripts), you
ma y ask to proceed in form a pau peris (as a poor person). To do th at , you must fill out th e last
page of th is form. Also, you m ust subm it a certificat e signed by an officer a t t he inst itut ion
where you are confined showing the amount of money that the institution is holding for you.
7. In th is motion, you ma y cha llenge th e judgmen t ent ered by only one cour t. If you wan t to
challenge a judgment entered by a different judge or division (either in the same district or in a
different district), you must file a separate motion.
8. When you ha ve completed th e form, send t he original an d two copies to the Clerk of th e United
Stat es District Court at t his address:
Clerk, United States District Court for AddressCity, Sta te Zip Code
9. C AU T IO N : Yo u m u s t i n c l u d e i n t h i s m o t i o n a l l t h e g r o u n d s f o r r e l i e f f r o m t h e
c o n v ic t i on o r s e n t e n c e t h a t y o u c h a l le n g e . An d y o u m u s t s t a t e t h e fa c t s t h a t s u p p o r t
e a c h g r o u n d . I f y o u fa i l t o s e t fo r t h a l l t h e g r o u n d s i n t h i s m o t i o n , y o u m a y b e b a r r e dfr o m p r e s e n t i n g a d d i t io n a l g r o u n d s a t a l a t e r d a t e .
10. C AP I T AL C AS E S : I f yo u a r e u n d e r a s e n t e n c e o f d e a t h , y o u a r e e n t i t le d t o t h e
a s s is t a n c e o f co u n s e l a n d s h o u l d r e q u e s t t h e a p p o i n t m e n t o f c o u n s e l.
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MOTION UND ER 28 U.S.C. § 2255 TO VACATE , SET ASIDE , OR CORR ECT
SENTENCE BY A PERSON IN FEDERAL CUSTODY
U n i t e d S t a t e s Di s t r i c t C ou r t District
Name (under which you were convicted): Docket or Case No.:
Place of Confinement : Prisoner No.:
UNI TED STATES OF AMERICA Movant (include name under which you were convicted)
v.
MOTION
1. (a) Name an d location of cour t th at en ter ed the judgment of conviction you ar e cha llenging:
(b) Criminal docket or case number (if you know):
2. (a) Dat e of th e jud gmen t of conviction (if you know):
(b) Dat e of senten cing:
3. Lengt h of sent ence:
4. Na tu re of crime (all coun ts ):
5. (a) Wha t was your plea? (Check one)
(1) Not guilty “ (2) Guilty “ (3) Nolo cont end ere (no cont est ) “ (b) If you enter ed a guilty plea to one count or ind ictm ent , and a not guilty plea to an other count
or indictment, what did you plead guilty to and what did you plead not guilty to?
6. I f you went to t r i a l, what k ind of t r i a l d id you have? (Check one) Jury “ Judge only “
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(4) Nat ur e of the pr oceeding:
(5) Grounds raised:
(6) Did you r eceive a h ear ing wher e evidence was given on your m otion, pet ition, or application? Yes “ No “(7) Result : (8) Date of result (if you kn ow):
(b) If you filed an y second motion, petition, or a pplicat ion, give th e sa me inform at ion:
(1) Name of court:
(2) Docket or case number (if you know):
(3) Date of filing (if you know):
(4) Nat ur e of the pr oceeding:
(5) Grounds raised:
(6) Did you r eceive a h ear ing wher e evidence was given on your m otion, pet ition, or application? Yes “ No “(7) Result : (8) Dat e of result (if you kn ow):
(c) Did you appea l to a federal ap pellate cour t h aving jurisdiction over th e action ta ken on your
motion, petition, or app licat ion?
(1) Fir st pet ition: Yes “ No “ (2) Second pet ition : Yes “ No “
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Docket or case n um ber (if you k now):
Date of the court’s decision:
Result (attach a copy of the court’s opinion or order, if available):
(3) Did you r eceive a hea ring on your motion, petition, or a pplicat ion?
Yes “ No “ (4) Did you a ppeal from t he den ial of your motion, petition, or application?
Yes “ No “ (5) If your an swer t o Question (c)(4) is “Yes,” did you ra ise th is issue in t he a ppeal?
Yes “ No “ (6) If your a nswe r t o Quest ion (c)(4) is “Yes,” st at e:
Name and location of the court where the appeal was filed:
Docket or case n um ber (if you k now):
Date of the court’s decision:
Result (attach a copy of the court’s opinion or order, if available):
(7) If your an swer to Qu est ion (c)(4) or Qu est ion (c)(5) is “No,” explain why you d id not app eal or
raise th is issue:
GROUND TWO :
(a) Supp orting facts (Do not ar gue or cite law. J ust st at e the specific facts th at su pport your claim.):
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(b) D i r e c t Ap p e a l o f G r o u n d T w o :
(1) If you appea led from th e judgment of conviction, did you r aise t his issu e?
Yes “ No “ (2) If you did not ra ise this issu e in your direct ap peal, explain why:
(c) P o s t -C o n v i c t i on P r o c e e d i n g s :
(1) Did you r aise t his issu e in a ny post-conviction motion, petition, or ap plicat ion?
Yes “ No “ (2) If your a nswe r t o Quest ion (c)(1) is “Yes,” st at e:
Type of motion or petition:
Na me an d location of the cour t wher e th e motion or petit ion was filed:
Docket or case n um ber (if you k now):
Date of the court’s decision:
Result (attach a copy of the court’s opinion or order, if available):
(3) Did you r eceive a hea ring on your motion, petition, or a pplicat ion?
Yes “ No “ (4) Did you a ppeal from t he den ial of your motion, petition, or application?
Yes “ No “ (5) If your an swer t o Question (c)(4) is “Yes,” did you ra ise th is issue in t he a ppeal?
Yes “ No “ (6) If your a nswe r t o Quest ion (c)(4) is “Yes,” st at e:
Name and location of the court where the appeal was filed:
Docket or case n um ber (if you k now):
Date of the court’s decision:
Result (attach a copy of the court’s opinion or order, if available):
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(7) If your an swer to Qu est ion (c)(4) or Qu est ion (c)(5) is “No,” explain why you d id not app eal or
raise th is issue:
G R O U N D TH R EE :
(a) Supp orting facts (Do not ar gue or cite law. J ust st at e the specific facts th at su pport your claim.):
(b) D ir e c t A p p e a l o f G r o u n d T h r e e :
(1) If you appea led from th e judgment of conviction, did you r aise t his issu e?
Yes “ No “ (2) If you did not ra ise this issu e in your direct ap peal, explain why:
(c) P o s t -C o n v i c t i on P r o c e e d i n g s :
(1) Did you r aise t his issu e in a ny post-conviction motion, petition, or ap plicat ion?
Yes “ No “ (2) If your a nswe r t o Quest ion (c)(1) is “Yes,” st at e:
Type of motion or petition:
Na me an d location of the cour t wher e th e motion or petit ion was filed:
Docket or case n um ber (if you k now):
Date of the court’s decision:
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Result (attach a copy of the court’s opinion or order, if available):
(3) Did you r eceive a hea ring on your motion, petition, or a pplicat ion?
Yes “ No “ (4) Did you a ppeal from t he den ial of your motion, petition, or application?
Yes “ No “ (5) If your an swer t o Question (c)(4) is “Yes,” did you ra ise th is issue in t he a ppeal?
Yes “ No “ (6) If your a nswe r t o Quest ion (c)(4) is “Yes,” st at e:
Name and location of the court where the appeal was filed:
Docket or case n um ber (if you k now):
Date of the court’s decision:
Result (attach a copy of the court’s opinion or order, if available):
(7) If your an swer to Qu est ion (c)(4) or Qu est ion (c)(5) is “No,” explain why you d id not app eal or
raise th is issue:
G R O U N D FO U R :
(a) Supp orting facts (Do not ar gue or cite law. J ust st at e the specific facts th at su pport your claim.):
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(7) If your an swer to Qu est ion (c)(4) or Qu est ion (c)(5) is “No,” explain why you d id not app eal or
raise th is issue:
13. Is th ere an y ground in th is motion t hat you ha ve not pr eviously presented in some federal court ?
If so, which ground or grounds have not been presented, and state your reasons for not
present ing them:
14. Do you ha ve an y motion, petition, or a ppeal n ow pending (filed and not decided yet) in a ny cour t
for th e judgmen t you ar e challenging? Yes “ No “ If “Yes,” sta te t he n am e an d locat ion of the cour t, th e docket or case n um ber, th e type of
proceeding, and the issues raised.
15. Give th e na me an d addr ess, if kn own, of each at torn ey who repr esent ed you in t he following
stages of the judgment you are challenging:
(a) At preliminary hearing:
(b) At a rra ignment and plea:
(c) At t ria l:
(d) At sent encing:
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(e) On a ppeal:
(f) In any post-conviction proceeding:
(g) On app eal from an y ru ling again st you in a p ost-conviction pr oceeding:
16. Were you sent enced on m ore than one count of an indictmen t, or on more tha n one indictmen t, in
the same court and at the same time? Yes “ No “ 17. Do you have an y futu re sent ence to serve after you complete th e sentence for the judgment tha t
you ar e challen ging? Yes “ No “ (a) If so, give nam e and locat ion of cour t th at im posed the other s ent ence you will serve in th e
future:
(b) Give the date the other sentence was imposed: (c) Give the length of th e other sent ence: (d) Ha ve you filed, or do you pla n t o file, an y motion, pet ition, or a pplicat ion t ha t cha llenges the
judgmen t or sentence to be served in th e futur e? Yes “ No “
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18. TIMELINE SS OF MOTION: If your jud gment of conviction becam e final over one year ago, you
mu st explain wh y the one-year sta tu te of limitat ions a s cont ained in 28 U.S.C. § 2255 does not
bar your motion.*
* The Antiter rorism a nd Effective Deat h P enalt y Act of 1996 (“AEDPA”) as cont ained in 28 U .S.C.
§ 2255, para graph 6, provides in par t t hat :
A one-year per iod of limitat ion sha ll apply to a motion un der t his section. The limitat ion period
shall run from t he latest of —
(1) th e dat e on which t he judgm ent of conviction becam e fina l;(2) the date on which the impediment t o making a motion creat ed by government al action inviolation of th e Const itut ion or laws of th e United St at es is removed, if th e m ovant was prevented from m aking such a motion by such government al action;(3) the date on which the right a sserted wa s initially recognized by th e Supr eme Court, if tha t r ight has been newly recognized by the Suprem e Court and made r etroactivelyapplicable to cases on collateral review; or (4) th e dat e on wh ich t he facts support ing th e claim or claims p resen ted could ha ve beendiscovered th rough th e exercise of due diligence.
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Therefore, movant asks tha t the Court grant the following relief:
or any other r elief to which movant ma y be entitled.
Signature of Attorney (if any)
I declar e (or certify, verify, or st at e) under p ena lty of perjur y tha t t he foregoing is tr ue a nd correct
and that this Motion under 28 U.S.C. § 2255 was placed in the prison mailing system on
(month, date, year).
Execut ed (signed) on (date).
Signa tur e of Movan t
If the person signing is not m ovant , stat e relationship to movant and explain why movant is n ot
signing this motion.
IN FORMA PAUPERIS DECLARATION
[Insert appropriate court ]
* * * * *