Fill - Free fillable Case Evaluation Form PDF form

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 “victim” known to each other? Yes ___ No ___ If so,

briefly describe the relationship.

_____________________________________________________________

25. What was the prosecution’s theory at trial?

_____________________________________________________________

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?

_____________________________________________________________

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.

_____________________________________________________________

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)?

_____________________________________________________________

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).

_____________________________________________________________

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?

_____________________________________________________________

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).

_____________________________________________________________

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 attorney’s 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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