Fillable PETITION FOR A WRIT OF HABEAS CORPUS UNDER (US Courts)

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PETITION FOR A WRIT OF HABEAS CORPUS UNDER (US Courts)

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*#3, and #6-9 were modified or added to reflect FLSD procedures
**#10 Paragraph 10(b) modified
AO 242 (05/12) Petition for a Writ of Habeas Corpus Under 28 U.S.C. § 2241 (Modified by FLSD 05/15/2012)*
PETITION FOR A WRIT OF HABEAS CORPUS UNDER 28 U.S.C. § 2241
Instructions
1. Who Should Use This Form. You should use this form if
• you are a federal prisoner and you wish to challenge the way your sentence is being carried out (for example, you
claim that the Bureau of Prisons miscalculated your sentence or failed to properly award good time credits);
• you are in federal or state custody because of something other than a judgment of conviction (for example, you are
in pretrial detention or are awaiting extradition); or
• you are alleging that you are illegally detained in immigration custody.
2. Who Should Not Use This Form. You should not use this form if
• you are challenging the validity of a federal judgment of conviction and sentence (these challenges are generally
raised in a motion under 28 U.S.C. § 2255);
• you are challenging the validity of a state judgment of conviction and sentence (these challenges are generally raised
in a petition under 28 U.S.C. § 2254); or
• you are challenging a final order of removal in an immigration case (these challenges are generally raised in a
petition for review directly with a United States Court of Appeals).
3. Preparing the Petition. The petition must be typed or neatly written, and you must sign and date it under penalty of perjury.
A false statement may lead to prosecution.
All questions must be answered clearly and concisely in the space on the form. If needed, you may attach additional pages or
file a memorandum in support of the petition. If you attach additional pages, number the pages and identify which section of
the petition is being continued. Note that some courts have page limitations. All filings must be submitted on paper sized 8½
by 11 inches. Do not use the back of any page.
No citation of authorities need be furnished. If a brief or additional argument is submitted. It should be submitted in the form
of a separate memorandum of law, not to exceed 20 pages in length absent prior leave of Court.*
4. Supporting Documents. In addition to your petition, you must send to the court a copy of the decisions you are challenging
and a copy of any briefs or administrative remedy forms filed in your case.
5. Required Filing Fee. You must include the $5 filing fee required by 28 U.S.C. § 1914(a). If you are unable to pay the filing
fee, you must ask the court for permission to proceed in forma pauperis – that is, as a person who cannot pay the filing fee –
by submitting the documents that the court requires.
6. Submitting Documents to the Court. Mail your petition and one copy to the clerk of the United States District Court for
the district and division in which you are confined (see below). All copies must be identical to the original. Copies may be
legibly hand written. If you want a file-stamped copy of the petition, you must enclose an additional copy of the petition and
ask the court to file-stamp it and return it to you.*
Miami Division Fort Lauderdale Division West Palm Beach Division
Clerk, U.S. District Court Clerk, U.S. District Court Clerk, U.S. District Court
400 N. Miami Ave., #8N09 299 E. Broward Boulevard 701 Clematis Street
Miami, FL 33128 Fort Lauderdale, FL 33301 West Palm Beach, FL 33401
7. Change of Address. You must immediately advise the Court of any changes of address by filing a “Notice to the Court of
Change of Address.” This notice should contain the address change and the effective date and must be signed. FAILURE TO
NOTIFY THE COURT OF ANY CHANGE OFA DDRESS COULD RESULT IN THE DISMISSAL OF YOUR
PETITION.
8. Petitioner is advised that respondent is not required to respond to the petition unless ordered by the Court and that default is
inappropriate in habeas corpus proceedings. Once the Court has ordered a response and counsel for respondent has appeared
in the case, any documents you file with the Court must also be sent to counsel. All filings must include a certificate of
service stating the date that a copy was served or mailed to counsel.
9. After receiving notice of your case number from the clerk, you must include the case number on all documents you file with
the Court. You must keep a copy of every document you send to the Court as you are not entitled to free copies from the
clerk even if you are proceeding in forma pauperis.
AO 242 (12/11) Petition for a Writ of Habeas Corpus Under 28 U.S.C. § 2241
Page 2 of 10
UNITED STATES DISTRICT COURT
for the
__________ District of __________
)
)
)
)
)
)
)
)
)
)
Petitioner
v.
Case No.
(Supplied by Clerk of Court)
Respondent
(name of warden or authorized person having custody of petitioner)
PETITION FOR A WRIT OF HABEAS CORPUS UNDER 28 U.S.C. § 2241
Personal Information
1. (a) Your full name:
(b) Other names you have used:
2. Place of confinement:
(a) Name of institution:
(b) Address:
(c) Your identification number:
3. Are you currently being held on orders by:
’ Federal authorities ’ State authorities ’ Other - explain:
4. Are you currently:
’ A pretrial detainee (waiting for trial on criminal charges)
’ Serving a sentence (incarceration, parole, probation, etc.) after having been convicted of a crime
If you are currently serving a sentence, provide:
(a) Name and location of court that sentenced you:
(b) Docket number of criminal case:
(c) Date of sentencing:
’ Being held on an immigration charge
’ Other
(explain):
AO 242 (12/11) Petition for a Writ of Habeas Corpus Under 28 U.S.C. § 2241
Page 3 of 10
Decision or Action You Are Challenging
5. What are you challenging in this petition:
’ How your sentence is being carried out, calculated, or credited by prison or parole authorities (for example,
revocation or calculation of good time credits)
’ Pretrial detention
’ Immigration detention
’ Detainer
’ The validity of your conviction or sentence as imposed (for example, sentence beyond the statutory
maximum or improperly calculated under the sentencing guidelines)
’ Disciplinary proceedings
’ Other
(explain):
6. Provide more information about the decision or action you are challenging:
(a) Name and location of the agency or court:
(b) Docket number, case number, or opinion number:
(c) Decision or action you are challenging
(for disciplinary proceedings, specify the penalties imposed):
(d) Date of the decision or action:
Your Earlier Challenges of the Decision or Action
7. First appeal
Did you appeal the decision, file a grievance, or seek an administrative remedy?
’ Yes ’ No
(a) If “Yes,” provide:
(1) Name of the authority, agency, or court:
(2) Date of filing:
(3) Docket number, case number, or opinion number:
(4) Result:
(5) Date of result:
(6) Issues raised:
AO 242 (12/11) Petition for a Writ of Habeas Corpus Under 28 U.S.C. § 2241
Page 4 of 10
(b) If you answered “No,” explain why you did not appeal:
8. Second appeal
After the first appeal, did you file a second appeal to a higher authority, agency, or court?
’ Yes ’ No
(a) If “Yes,” provide:
(1) Name of the authority, agency, or court:
(2) Date of filing:
(3) Docket number, case number, or opinion number:
(4) Result:
(5) Date of result:
(6) Issues raised:
(b) If you answered “No,” explain why you did not file a second appeal:
9. Third appeal
After the second appeal, did you file a third appeal to a higher authority, agency, or court?
’ Yes ’ No
(a) If “Yes,” provide:
(1) Name of the authority, agency, or court:
(2) Date of filing:
(3) Docket number, case number, or opinion number:
(4) Result:
(5) Date of result:
(6) Issues raised:
AO 242 (12/11) Petition for a Writ of Habeas Corpus Under 28 U.S.C. § 2241
Page 5 of 10
(b) If you answered “No,” explain why you did not file a third appeal:
10. Motion under 28 U.S.C. § 2255
In this petition, are you challenging the validity of your conviction or sentence as imposed?
’ Yes ’ No
If “Yes,” answer the following:
(a) Have you already filed a motion under 28 U.S.C. § 2255 that challenged this conviction or sentence?
’ Yes ’ No
If “Yes,” provide:
(1) Name of court:
(2) Case number:
(3) Date of filing:
(4) Result:
(5) Date of result:
(6) Issues raised:
(b) Have you ever filed a motion in a United States Court of Appeals under 28 U.S.C. § 2244(b)(3)(A),
seeking permission to file a second or successive Section 2255 motion
or a Section 2254 to petition
to challenge this conviction or sentence?**
’ Yes ’ No
If “Yes,” provide:
(1) Nam
e of court:
(2) Case
number:
(3) Date of filing:
(4) Result:
(5) Date of result:
(6) Issues raised:
AO 242 (12/11) Petition for a Writ of Habeas Corpus Under 28 U.S.C. § 2241
Page 6 of 10
(c) Explain why the remedy under 28 U.S.C. § 2255 is inadequate or ineffective to challenge your
conviction or sentence:
11. Appeals of immigration proceedings
Does this case concern immigration proceedings?
’ Yes ’ No
If “Yes,” provide:
(a) Date you were taken into immigration custody:
(b) Date of the removal or reinstatement order:
(c) Did you file an appeal with the Board of Immigration Appeals?
’ Yes ’ No
If “Yes,” provide:
(1) Date of filing:
(2) Case number:
(3) Result:
(4) Date of result:
(5) Issues raised:
(d) Did you appeal the decision to the United States Court of Appeals?
’ Yes ’ No
If “Yes,” provide:
(1) Name of court:
(2) Date of filing:
(3) Case number:
AO 242 (12/11) Petition for a Writ of Habeas Corpus Under 28 U.S.C. § 2241
Page 7 of 10
(4) Result:
(5) Date of result:
(6) Issues raised:
12. Other appeals
Other than the appeals you listed above, have you filed any other petition, application, or motion about the issues
raised in this petition?
’ Yes ’ No
If “Yes,” provide:
(a) Kind of petition, motion, or application:
(b) Name of the authority, agency, or court:
(c) Date of filing:
(d) Docket number, case number, or opinion number:
(e) Result:
(f) Date of result:
(g) Issues raised:
Grounds for Your Challenge in This Petition
13. State every ground (reason) that supports your claim that you are being held in violation of the Constitution,
laws, or treaties of the United States. Attach additional pages if you have more than four grounds. State the
facts supporting each ground.
GROUND ONE:
AO 242 (12/11) Petition for a Writ of Habeas Corpus Under 28 U.S.C. § 2241
Page 8 of 10
(a) Supporting facts (Be brief. Do not cite cases or law.):
(b) Did you present Ground One in all appeals that were available to you?
’ Yes ’ No
GROUND TWO:
(a) Supporting facts
(Be brief. Do not cite cases or law.):
(b) Did you present Ground Two in all appeals that were available to you?
’ Yes ’ No
GROUND THREE:
(a) Supporting facts
(Be brief. Do not cite cases or law.):
(b) Did you present Ground Three in all appeals that were available to you?
’ Yes ’ No
AO 242 (12/11) Petition for a Writ of Habeas Corpus Under 28 U.S.C. § 2241
Page 9 of 10
GROUND FOUR:
(a) Supporting facts
(Be brief. Do not cite cases or law.):
(b) Did you present Ground Four in all appeals that were available to you?
’ Yes ’ No
14. If there are any grounds that you did not present in all appeals that were available to you, explain why you did
not:
Request for Relief
15. State exactly what you want the court to do:
AO 242 (12/11) Petition for a Writ of Habeas Corpus Under 28 U.S.C. § 2241
Page 10 of 10
Declaration Under Penalty Of Perjury
If you are incarcerated, on what date did you place this petition in the prison mail system:
I declare under penalty of perjury that I am the petitioner, I have read this petition or had it read to me, and the
information in this petition is true and correct. I understand that a false statement of a material fact may serve as the basis
for prosecution for perjury.
Date:
Signature of Petitioner
Signature of Attorney or other authorized person, if any
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PETITION FOR A WRIT OF HABEAS CORPUS UNDER (US Courts)

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Completed 20 November 2020

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