Rev. 2019
Application a Commutation of Sentence, Page 1 of 2
Governor Gavin Newsom · State Capitol ·Sacramento, California 95814
APPLICATION FOR A COMMUTATION OF SENTENCE
Complete this application to request a commutation of sentence (a reduction of sentence/punishment) from the Governor. If you
have submitted a commutation application in the last three years, please complete the re-application form. The Governor’s Office
and/or the Board of Parole Hearings may contact you for additional information relating to this application. If the Governor grants
you a commutation, some information from your application will appear in an annual public report about clemency
the Governor is required to submit to the California Legislature. Learn more about commutation application at
www.gov.ca.gov/clemency or mail a request for information to: Office of the Governor, State Capitol, Attn: Legal Affairs/Clemency,
Sacramento, CA 95814.
APPLICANT INFORMATION
(Attach additional pages as necessary.)
Name (Last/First/Middle): __________________________________________________ Date of Birth: _________________________
CDCR Number: ________________________________ Social Security Number: ____________________________________________
Name of Facility/Prison: _____________________________ Facility/Prison Address:_______________________________________
1. Conviction Summary (Note: The Governor’s Office will review a complete copy of your criminal history report.)
Crime(s):
Date(s) of conviction:
County of conviction(s):
Sentence(s):
Were you u
nder 26 years of age at the time of the crime(s) for which you are seeking a commutation of sentence? YES NO
Crime(s):
Date(s) of conviction:
Location of conviction(s):
Sentence(s):
Rev. 2019
Application for Commutation of Sentence, Page 2 of 2
2. Describe the circumstances of your crime(s).
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
3. Describe how a commutation of sentence may impact your life.
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
___________________________
_______________________________________________________________________________________________
4. Describe your life since your conviction (e.g., efforts in self-development, including identifying and addressing treatment needs,
professional and educational achievement; any set-backs, conduct violations, or new convictions; insight about past conduct; and
future goals).
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
___________________________
_______________________________________________________________________________________________
5. If
you have paid any money or given any gift to anyone to assist you in preparing this application, you are required by law to list
their name, address, phone number, email address, the nature of your relationship, and amount paid or gift given.
_______
_____________________________________________________________________________________________________
AP
PLICANT DECLARATION
Complete the following statement after you have served your Notice of Intent
I,
___________________________________________, declare under penalty of perjury under the laws of the State of
(Print Applicant Full Name)
California that the information I have provided on this application is true and correct. I further declare that I have served (mailed or
delivered) my notice of intent to apply for clemency on the District Attorney of the County of ________________________________.
(Name of County or Counties)
_________________________________________ ___________________________________________
Applicant Signature Date
Subm
it this completed 2-page form to the Office of the Governor, State Capitol, Attn: Legal Affairs/Clemency, Sacramento, CA 95814.
You may, but are not required to, include copies of relevant documents that support your application (e.g., certificates of achievement,
photographs, letters of support, etc.). Do not send original documents, as application documents cannot be returned. Please update
the Governor’s Office promptly if your contact information changes. Submit a completed Notice of Intent to Apply for Clemency
to
the district attorney in the county of your convictions for which you are seeking a commutation of sentence.
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