QUESTIONNAIRE
When completing this Questionnaire bear in mind that we focus on cases of factual
innocence. It is assumed that this form is being completed by the individual seeking
EXI’s assistance. If filled out by another person, please specify in question 2 with
your name, contact information and your relationship to the person seeking help.
Please try to stay within the lines provided for each response. Additional pages
should only if absolutely necessary. Do not send additional papers unless you are
contacted by us and requested to do so.
BACKGROUND INFORMATION
1. Name. _______________________________________________________
2. Address and prison number. If not incarcerated provide telephone
number(s) including cellular.
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
3. Date this Questionnaire is completed.
_____________________________________________________________
4. Age and date of birth.
_____________________________________________________________
5. What crime or crimes were you convicted of?
_____________________________________________________________
_____________________________________________________________
6. Date of the crime? ______________________________________________
233 Broadway Suite 2370 New York, NY 10279 P 212.965.9335 F 212.965.9375 www.exi.org
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7. Date of the conviction? __________________________________________
8. What sentence was imposed? _____________________________________
9. What is the projected release date? ________________________________
10. What court did the conviction occur in? If state, indicate state and county
(example: NY State, Kings County). If federal, indicate the district
(example: SDNY).
_____________________________________________________________
11. What is the Indictment or Docket case number for the conviction? This is
usually the Docket or Indictment Number.
_____________________________________________________________
12. Was the conviction by jury verdict, bench trial, or guilty plea?
_____________________________________________________________
13. Name of the judge presiding over the trial and/or the sentencing.
_____________________________________________________________
14. Name of the trial prosecutor and his/her office address.
_____________________________________________________________
_____________________________________________________________
15. Name, address and telephone numbers, including cellulars, of defense
counsel at all proceedings:
Trial: ______________________________________________
______________________________________________
Appeal: ______________________________________________
______________________________________________
Post-Conviction: ______________________________________________
______________________________________________
Other: ______________________________________________
______________________________________________
16. If you are currently represented, provide the name, address and telephone
numbers, including cellular, of current lawyer.
_____________________________________________________________
_____________________________________________________________
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17. Name(s) of co-defendant(s) and current locations and addresses.
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
18. Do you have a prior criminal history? Yes ___ No ___ (Provide: charges, of
courts, dates, and sentences of other convictions).
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
19. If currently serving time on more than one case, please state when the
sentences for each case commenced, the length of the sentences on the
wrongful conviction case and on the other case(s), and the release dates on
each case.
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
20. The educational background of the person convicted. (Example: highest
grade in school and degrees if any).
_____________________________________________________________
_____________________________________________________________
GENERAL CASE INFORMATION
21. Briefly state the nature of the case (example: murder by stabbing, rape of
child).
_____________________________________________________________
_____________________________________________________________
22. Date of the arrest? ______________________________________________
23. If the arrest was not immediate, briefly explain the delay.
_____________________________________________________________
_____________________________________________________________
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24. Are you and the victimknown to each other? Yes ___ No ___ If so,
briefly describe the relationship.
_____________________________________________________________
_____________________________________________________________
25. What was the prosecution’s theory at trial?
_____________________________________________________________
_____________________________________________________________
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26. Name the witnesses to the alleged crime who testified for the prosecution at
trial and briefly describe what they testified to.
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
27. Did physical evidence link you to the crime (example: weapon, clothing,
vehicle, personal effects)? Yes ___ No ___ If so, briefly state the
significance of such evidence to the conviction.
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
28. What was the defense theory at trial, if any?
_____________________________________________________________
_____________________________________________________________
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_____________________________________________________________
29. Names of the witnesses called by the defense to support the defense theory
and briefly describe their testimony?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
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30. If you have an alibi, was it offered at trial? Yes ___ No ___ Provide the
name(s) of the alibi witness(es), addresses and telephone numbers (if
known), and briefly explain the alibi testimony.
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
31. Did you testify at trial? Yes ___ No ___
32. If yes, briefly explain your testimony.
_____________________________________________________________
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_____________________________________________________________
33. Was any evidence suppressed at the pre-trial phase of the case?
Yes ___ No ___
_____________________________________________________________
34. If so, identify the evidence and briefly explain why it was suppressed.
_____________________________________________________________
_____________________________________________________________
EYEWITNESS IDENTIFICATION
35. Was eyewitness identification offered against you at trial? Yes ___ No ___
_____________________________________________________________
36. How long after the crime were you identified?
_____________________________________________________________
_____________________________________________________________
37. Name the eyewitnesses who identified you, the date and place of the
identification, and the procedure used? (examples: show-up, line-up, photo
array).
Witness Date Place Procedure
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
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38. Did the identifying witness(es) know you? Yes ___ No ___ If so what was
your relationship with the witness(es)?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
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NON-EXPERT WITNESSES WITH INCENTIVES
39. Describe the relationship between you and the important non-expert
witnesses who testified against you, and their incentives to lie. (Example:
cooperated with prosecution; disliked you).
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
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CONFESSION
40. Was a confession(s) or incriminating statement(s) said to have been made by
you that was offered against you at trial? Yes ___ No ___
_____________________________________________________________
41. Did you confess or were you alleged to have confessed to any civilians
before or after confessing or allegedly confessing to the police?
Yes ___ No ___
_____________________________________________________________
42. If so, who did you confess or were you alleged to have confessed to and
what was the relationship between you and that person?
_____________________________________________________________
_____________________________________________________________
43. What was your age at the time of the confession(s)?
_____________________________________________________________
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44. What factor may have contributed to the false confession(s)?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
EXPERTS
45. Did an expert testify against you at trial? Yes ___ No ___
_____________________________________________________________
46. If so, what type of expert and what did s/he testify to? (For example: arson,
tool marks, bite marks, fingerprints, rape trauma, psychological or
psychiatric).
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
47. If so, what type of expert and what did s/he testify to?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
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DNA
48. Was any biological evidence recovered during the investigation linking you
or another person to the crime? Yes ___ No ___ Please indicate in the
appropriate space below who the biological evidence related to.
Blood: ___________________________________________________
Semen: ___________________________________________________
Saliva: ___________________________________________________
Hair: ___________________________________________________
Other: ___________________________________________________
49. Was the biological evidence tested? Yes ___ No ___ If tested what were
the results?
_____________________________________________________________
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50. What was the significance of the biological evidence to the conviction?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
51. Was DNA evidence used at trial? Yes ___ No ___ If so, state the nature of
the DNA (examples: blood, semen, saliva), and the impact it had on the
conviction.
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
52. Was DNA or other biological or physical evidence collected and NOT used
at trial? Yes ___ No ___ If so, what was the evidence, why was it not used,
and what is its significance to innocence?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
APPEALS
53. Was the conviction appealed? Yes ___ No ___
_____________________________________________________________
54. If yes, indicate the appellate court, the issues (briefly), the decision, the date
of the decision and the appellate docket numbers. If appeal pending, please
indicate in Decision/Date space below. If multiple appeals, use an additional
sheet of paper if needed.
Court: ______________________________________________
Issues: ______________________________________________
______________________________________________
______________________________________________
Decision/Date: ______________________________________________
Docket No. ______________________________________________
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55. Is it is believed that trial counsel provided ineffective assistance?
Yes ___ No ___ If so, briefly explain.
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
POST-CONVICTION LITIGATION
56. List all post-trial/post-conviction litigation, indicating the nature of the
proceeding, the court in which it was filed, the judge’s name, the date filed,
the determination reached, and the date of the final decision or if pending
(examples: 440.10 (g) motion, Bronx Supreme Court (Smith, J.), filed
1/1/2000, denied 5/1/2000; 2254 Eastern District of N.Y. (Doe, J.), filed
6/1/2007, pending).
_____________________________________________________________
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_____________________________________________________________
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_____________________________________________________________
_____________________________________________________________
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57. Briefly describe the grounds for the post-trial/post-conviction motion, and if
denied the basis for the denial.
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
58. If an attorney filed the post-trial/post-conviction motion for you, or handled
any of the proceedings, please state the attorneys name, address, telephone
and cellular numbers.
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
NEWLY DISCOVERED EVIDENCE
59. Is there newly discovered evidence that was unavailable at trial that can now
prove innocence? Yes ___ No ___ If so, what is the nature and form of the
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newly discovered evidence (examples: DNA/blood, witness recantation, new
witness, affidavit)?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
60. When was the newly discovered evidence discovered?
_____________________________________________________________
61. How was the newly discovered evidence discovered?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
62. Why wasn’t the newly discovered evidence discovered earlier?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
63. If the newly discovered evidence is a witness or witnesses, why are they
willing to cooperate now, but were not at the time of trial?
_____________________________________________________________
64. Was the newly discovered evidence used in any post-trial proceedings?
Yes ___ No ___ If so, how was it used (examples: biological evidence,
affidavits submitted with motion, expert report)?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
65. Were there any witnesses available at trial and that were favorable to you
who did NOT testify at trial? Yes ___ No ___ If so, provide their names
and contact information, describe what they would have testified to, and
explain why they did not testify.
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
66. Was there any physical or documentary evidence available at the time of
trial that was favorable to you that was NOT offered at trial?
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Yes ___ No ___ If so, briefly describe the evidence, indicate why it was
not offered and where it is located.
_____________________________________________________________
_____________________________________________________________
67. Did you or any witnesses take polygraph tests? Yes ___ No ___ If so, who
took them, when, where they taken by a defense or prosecution expert, and
what were the results?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
68. Are you willing to take a polygraph test now?
Yes ___ No ___
RELEASE PAROLE INFORMATION
69. How many appearances have you made before the parole board?
70. When are you next due to appear before the parole board?
71. Did you maintain your innocence to parole officials? Yes ___ No ___
72. If so, on how many occasions? ____________________________________
REVIEW BY OTHERS
73. Was any other Innocence Project, Law School, clinic, attorney, or
investigator consulted with about this case? Yes ___ No ___ If yes,
provide the name, address, telephone, cellular, and email of the organization
and person consulted with.
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
74. Provide the date(s) of the consultation(s), the determination reached, and the
basis for the determination.
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
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This Questionnaire should be mailed to The Exoneration Initiative, at 233
Broadway, Suite 2370, New York, NY 10279, faxed to 212-965-9375, or scanned
and emailed to info@exi.org. If we believe that the case requires a closer look, we
will contact you. Be advised that we have a high volume of cases to review and
there may be substantial delay between our receipt of this Questionnaire and our
reply. Thank you in advance for your patience.
PLEASE BE SURE TO SIGN AND RETURN THE ATTACHED
AUTHORIZATION/WAIVER FORM WITH THIS COMPLETED
QUESTIONNAIRE
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AUTHORIZATION/WAIVER
This form must be signed by the wrongfully convicted person seeking review of
his/her case.
By signing below, I authorize the Exoneration Initiative to investigate my
case. I understand that my case may be assigned to a law student or other non-
lawyer working under the direct and immediate supervision of an attorney licensed
to practice law in New York. The investigation includes, but is not limited to,
authorizing correspondence and/or telephone calls to prior and current counsel,
prosecutors, witnesses and others familiar with the case. I understand that by
conducting an investigation, the Exoneration Initiative is not agreeing to represent
me. I further understand that at any point the Exoneration Initiative may, in its sole
discretion, determine that further investigation is not warranted, and that it is under
no obligation to continue its investigation or represent me.
I authorize the release of any and all information to attorneys, students or
personnel affiliated with the Exoneration Initiative relating to my case. This
includes, but is not limited to, the release of court transcripts, police reports,
witness statements, post-conviction pleadings and correctional records, including
pre-sentencing reports and other documents in prison files.
I authorize the Exoneration Initiative to discuss the merits of my claims, in
its discretion, with other attorneys and/or organizations that are interested in
evaluating my case for possible representation. I understand that this authorization
will remain in effect even if the Exoneration Initiative terminates review and
rejects my case. This authorization is effective until revoked by the undersigned in
writing.
Name (Printed): ____________________________________________________
Signature: Date:_______________
233 Broadway Suite 2370 New York, NY 10279 P 212.965.9335 F 212.965.9375 www.exi.org
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