Fillable APPENDIX A POST-CONVICTION HABEAS CORPUS FORM PETITION FOR (West Virginia Supreme Court of Appeals)

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APPENDIX A POST-CONVICTION HABEAS CORPUS FORM PETITION FOR (West Virginia Supreme Court of Appeals)

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APPENDIX A

POST-CONVICTION HABEAS CORPUS FORM

PETITION FOR WRIT OF HABEAS CORPUS

AD SUBJICIENDUM UNDER W. VA. CODE § 53-4A-1

Instructions - Read Carefully (Revised October 2005)

1. This petition must be legibly handwritten or typewritten, and signed by the petitioner under

penalty of perjury. Any false statement of a material fact may serve as the basis for

prosecution and conviction for perjury. All questions must be answered concisely in the

proper space on the form.

2. Additional pages are not permitted except with respect to the facts which you rely upon to

support your grounds for relief. No citation of authorities need be furnished. If briefs or

arguments are submitted, they should be submitted in the form of a separate memorandum.

3. Upon receipt of the required filing fee, your petition will be filed if it is in proper order.

4. If you do not have the necessary funds for fees, transcripts, counsel, and other costs

connected with a petition of this type, you may request permission to proceed in forma

pauperis, by executing the form attached as Appendix B, setting forth information

establishing your inability to pay the costs. If you wish to proceed in forma pauperis, you

must have an authorized officer at the penal institution complete the certificate as to the

amount of money on deposit to your credit in any account in the institution.

5. Your attention is directed to the fact that you must include all grounds for relief and all

facts supporting such grounds for relief in the petition you file seeking relief from any

judgment of conviction.

6. When the petition is fully completed, the original and at least two copies may be mailed to

(1) the clerk of the circuit court of the county where you are incarcerated; or (2) the clerk

of the circuit court of the county where you were convicted and sentenced. You may also

file the petition with the Clerk of the Supreme Court of Appeals. You are advised,

however, that the Supreme Court rarely grants relief on petitions originally filed there.

7. Petitions which do not conform to these instructions will be returned with a notation as to

the deficiency.

PETITION UNDER W. VA. CODE § 53-4A-1 FOR WRIT OF HABEAS CORPUS

STATE OF WEST VIRGINIA

County

Name Prisoner No. Case No.

Place of Confinement

Name of Petitioner (include name under which convicted) Name of Respondent (authorized person having custody of petitioner)

PETITION

1. Name and location of court which entered the judgment of conviction under attack _________________________________

_____________________________________________________________________________________________________

2. Date of judgment of conviction ___________________________________________________________________________

3. Length of sentence _____________________________________________________________________________________

4. Nature of offense involved (all counts) _____________________________________________________________________

_____________________________________________________________________________________________________

5. What was your plea? (Check one)

(a) Not guilty

(b) Guilty

If you entered a guilty plea to one count or indictment, and a not guilty plea to another count or indictment, give details:

_____________________________________________________________________________________________________

6. If you pleaded not guilty, what kind of trial did you have? (Check one)

(a) Jury

(b) Judge Only

7. Did you testify at the trial?

Yes No

8. Did you file a direct appeal from the judgment of conviction in the Supreme Court of Appeals?

Yes No

9. If you did appeal, answer the following:

(a) Date of filing ______________________________________________________________________________________

(b) Grounds raised ____________________________________________________________________________________

__________________________________________________________________________________________________

(d) If refused, what was date of refusal? ___________________________________________________________________

(e) If granted, give date and type of result and citation, if known. ______________________________________________

__________________________________________________________________________________________________

10. Other than a direct appeal from the judgment of conviction and sentence, have you previously filed any petitions, applications, or

motions with respect to this judgment in any court, state or federal?

Yes No

11. If your answer to 10 was “yes,” give the following information:

(a) (1) Name of court ________________________________________________________________________________

(2) Nature of proceeding ___________________________________________________________________________

_____________________________________________________________________________________________

(3) Grounds raised ________________________________________________________________________________

_____________________________________________________________________________________________

(4) Did you receive an evidentiary hearing on your petition, application or motion?

Yes No

(5) Result _______________________________________________________________________________________

(6) Date of result _________________________________________________________________________________

(b) As to any second petition, application or motion give the same information:

(1) Name of court ________________________________________________________________________________

(2) Nature of proceeding ___________________________________________________________________________

_____________________________________________________________________________________________

(3) Grounds raised ________________________________________________________________________________

_____________________________________________________________________________________________

(4) Did you receive an evidentiary hearing on your petition, application or motion?

Yes No

(5) Result _______________________________________________________________________________________

(6) Date of result _________________________________________________________________________________

(c) Did you appeal to the highest state court having jurisdiction the result of action taken on any petition, application or motion?

(1)First petition, etc. Yes No

(2)Second petition, etc. Yes No

(d) If you did not appeal from the adverse action on any petition, application or motion, explain briefly why you did not:

__________________________________________________________________________________________________

12. State concisely every ground on which you claim that you are being held unlawfully. Summarize briefly the facts supporting each

ground. If necessary, you may attach pages stating additional grounds and facts supporting same.

CAUTION: In order to proceed in the circuit court, you must state grounds that have NOT been previously and finally

adjudicated or waived. If you fail to set forth all grounds in this petition, you may be barred from presenting additional

grounds at a later date.

For your information, the following is a list of the most frequently raised grounds for relief in habeas corpus proceedings.

Each statement preceded by a letter constitutes a separate ground for possible relief. You may raise any grounds which you may

have other than those listed. However, you should raise in this petition all available grounds (relating to this conviction) on which

you base your allegations that you are being held in custody unlawfully.

Do not check any of these listed grounds. If you select one or more of these grounds for relief, you must allege facts. The

petition will be returned to you if you merely check (a) through (j) or any one of these grounds.

(a) Conviction obtained by plea of guilty which 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.

(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 which was unconstitutionally selected and impaneled.

(I) Denial of effective assistance of counsel.

(j) Denial of right of appeal.

A. Ground one: _______________________________________________________________________________________

__________________________________________________________________________________________________

Supporting FACTS (state briefly without citing cases or law) _______________________________________________

__________________________________________________________________________________________________

B. Ground two: ______________________________________________________________________________________

__________________________________________________________________________________________________

Supporting FACTS (state briefly without citing cases or law) _______________________________________________

__________________________________________________________________________________________________

C. Ground three: _____________________________________________________________________________________

__________________________________________________________________________________________________

Supporting FACTS (state briefly without citing cases or law) _______________________________________________

__________________________________________________________________________________________________

D. Ground four: ______________________________________________________________________________________

__________________________________________________________________________________________________

Supporting FACTS (state briefly without citing cases or law) _______________________________________________

__________________________________________________________________________________________________

13. If any of the grounds listed in 12A, B, C, and D were not previously presented in any other court, state or federal, state briefly what

grounds were not so presented, and give your reasons for not presenting them: ____________________________________

_____________________________________________________________________________________________________

14. Do you have any petition or appeal now pending in any court, either state or federal, as to the judgment under attack?

Yes No

15. Give the name and address, if known, of each attorney who represented you in the following stages of the judgment attacked herein:

(a) At preliminary hearing ______________________________________________________________________________

__________________________________________________________________________________________________

(b) At arraignment and plea _____________________________________________________________________________

__________________________________________________________________________________________________

(d) At sentencing ______________________________________________________________________________________

__________________________________________________________________________________________________

(e) On appeal _________________________________________________________________________________________

__________________________________________________________________________________________________

(f) In any post-conviction proceeding _____________________________________________________________________

__________________________________________________________________________________________________

(g) On appeal from any adverse ruling in a post-conviction proceeding __________________________________________

__________________________________________________________________________________________________

16. Have you, or an attorney representing you, obtained a transcript of the criminal proceedings which resulted in the conviction under

attack?

Yes No

17. If your answer to 16 was “no,” have you submitted an Appellate Transcript Request form for transcripts to the circuit court, a court

reporter, or any other tribunal or individual?

Yes No

18. If your answer to 17 was “yes,” attach a copy, if available, of the Appellate Transcript Request form and provide the name of the

court or person to whom it was submitted and the date of submission.

(a) Copy of request is attached

(b) Date

19. Were you sentenced on more than one count of an indictment, or on more than one indictment, in the same court and at the same

time?

Yes No

20. Do you have any future sentence to serve after you complete the sentence imposed by the judgment under attack?

Yes No

(a) If so, give name and location of court which imposed sentence to be served in the future: _______________________

__________________________________________________________________________________________________

(b) Give date and length of the above sentence: _____________________________________________________________

__________________________________________________________________________________________________

(c) Have you filed, or do you contemplate filing, any petition attacking the judgment which imposed the sentence to be served in

the future?

Yes No

Wherefore, petitioner prays that the Court grant petitioner relief to which he may be entitled in this proceeding.

_____________________________________________________

Signature of Attorney (if any)

I declare under penalty of perjury that the foregoing is true and correct.

Executed on ________________________________________________.

(date)

_____________________________________________________

Signature of Petitioner

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APPENDIX A POST-CONVICTION HABEAS CORPUS FORM PETITION FOR (West Virginia Supreme Court of Appeals)

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Completed 21 October 2021

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