Fillable PETITION FOR REPRIEVE, COMMUTATION, OR PARDON (Washington)

Fill Online, Printable, Fillable, Blank PETITION FOR REPRIEVE, COMMUTATION, OR PARDON (Washington) Form

Use Fill to complete blank online WASHINGTON pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

PETITION FOR REPRIEVE, COMMUTATION, OR PARDON (Washington)

On average this form takes 27 minutes to complete

The PETITION FOR REPRIEVE, COMMUTATION, OR PARDON (Washington) form is 8 pages long and contains:

  • 3 signatures
  • 0 check-boxes
  • 94 other fields

Country of origin: US
File type: PDF

BROWSE WASHINGTON FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Revised 01/19/2018 1
PETITION FOR REPRIEVE, COMMUTATION, OR PARDON
TO THE GOVERNOR OF THE STATE OF WASHINGTON:
Under the authority granted to the Governor pursuant to The Washington State
Constitution, Article III, Section 9, and RCW 10.01.120, the undersigned hereby makes
application for a pardon or commutation of sentence or reprieve and respectfully
represents the facts as follows:
NAME OF PETITIONER:
LAST Name FIRST Name MIDDLE Name
ALIASES, if any:
LAST Name FIRST Name MIDDLE Name
LAST Name FIRST Name MIDDLE Name
LAST Name FIRST Name MIDDLE Name
RESIDENCE
Address Apartment, Lot, Suite, Space, etc.
City State Zip Code
TELEPHONE NUMBER: EMAIL ADDRESS:
Date of Birth Place of Birth Citizenship Social Security Number Prison Number
DRIVER’S LICENSE NUMBER (Including State of Issuance):
Revised 01/19/2018 2
Specify the Action You Are Requesting of the Governor
PARDON (complete relief from sentence and/or disabilities related to conviction)
COMMUTATION (reduction of sentence)
REPRIEVE (delay in imposition of sentence)
Date of Application: _____________________
Have you previously applied for a commutation or pardon? YES
(If yes, WHEN?) _____________ NO
If less than three years have passed, are their new circumstances that you believe
justify your petition?
this application concerns medical issues Yes No
this application concerns deportation or removal issues Yes No
The Board reviews and hears Petitions for pardon or commutation only in cases in which
judicial remedies for the conviction have been concluded to a final decision. Have all
direct appeals been exhausted or has the time within which to appeal expired? YES
NO
If you are incarcerated, are you under the jurisdiction of the Indeterminate Sentencing
Review Board?
Are you on community custody for an offense that places you under the jurisdiction of
the Indeterminate Sentencing Review Board? Yes No
If you are represented by an attorney or other party pertaining to this Petition, please
indicate to whom all communications relating to this petition should be addressed.
NAME:
ADDRESS:
TELEPHONE:
Revised 01/19/2018 3
ARE YOU A U.S. CITIZEN? YES NO
Have you exhausted all other applicable remedies available to you under the law,
including a motion to vacate or motion to expunge or motion to seal the record?
YES NO
If yes, please attach all documentary evidence demonstrating your efforts and the
Court’s decision.
If not, please explain why:___________________________________________________
For Each Conviction(s) for Which You Are Seeking Pardon or Commutation (Use
additional paper, as needed, to complete your response.)
Crime or Offense:
Date of the Crime:
Date of Conviction:
County and State of Conviction:
Case Number:
Sentence Imposed:
Was there a Protective Order as a Result of this Crime:
If Yes, is it still active:_________________________________________
Restitution/Costs Imposed:
If Restitution/Costs Imposed, what amount have you paid?
Were you represented by an attorney: YES NO
If yes, please provide:
NAME:
ADDRESS:
TELEPHONE:
Revised 01/19/2018 4
Was a weapon used in perpetration of the crime(s)? YES NO
If yes, what kind: _________________________________________________________________________
If the offense was committed against a person, please answer the following:
1. Was the victim known to you?________________________________________________________
2. If yes, the relationship______________________________________________________________
3. Was the victim injured?______________________________________________________________
4. Age of victim at time of offense_______________________________________________________
5. More than one victim? If yes, how many?_______________________________________________
6. Was restitution ordered?______________________
If yes, how much and has it been paid?_________________________________________________
Please provide the following information:
Are you currently:
Serving a sentence? If yes, when is your earliest possible release date?
On parole? If yes, when is your discharge date?
On probation? If yes, when is your discharge date?
Prior Convictions:
Have you ever been arrested, charged, or convicted of any offense at any other time?
The Board expects that all offenses, including gross misdemeanor and misdemeanor offenses, will be
included in answer to this question.
If yes, please provide the following information for each offense (use additional paper, as needed, to
complete response for each conviction):
a. Crime or Offense:
b. Date of Crime or Offense:
c. Sentence Imposed and date:
d. County and state where convicted or charged:
Revised 01/19/2018 5
(A copy of the JUDGMENT AND SENTENCE for each offense for which you desire relief is
REQUIRED before the Board will review your petition. PLEASE ATTACH A COPY TO
THIS PETITION.)
Statement of All Pending Proceedings:
Please identify all cases that are pending against you in any State or Federal or local court, and provide
the nature of each such case pending against you. If you have no cases pending against you, you must
so state.
Identity of Court Case / Docket No. Status
Petitioner’s Statement:
(Use additional paper, as needed, to complete your response.)
For each conviction, fully explain the facts of the crime for which relief is being sought:
Please describe the “extraordinary” circumstances that you think would justify granting your Petition for
clemency:
Revised 01/19/2018 6
Please describe your rehabilitation efforts after your conviction, if any:
Describe your prison record, if any, (include commendations, disciplinary actions, etc.):
Are you currently, or have you at anytime in the past been, the subject of a do not contact order,
restraining order or protective order? YES NO
If Yes, for each such order, please describe, in detail, the nature of the order and identify the parties
and case in which such order was issued.
If yes, please attach a copy of each such Order.
Revised 01/19/2018 7
This petition and materials submitted with it will become a matter of public record once
received by the Clemency and Pardons Board.
Falsification of any portion of this application can be reason for denial.
This petition and materials submitted with it will become property of the Office of the Governor
and will not be returned to the petitioner. Please keep a copy of the petition and attachments
for your personal records.
I DECLARE UNDER PENALTY OF PERJURY THAT ALL THE CONTENTS OF THE ABOVE PETITION ARE
TRUE AND CORRECT. I am aware that all or some information on this application and any
information obtained by the Clemency and Pardons Board staff may be considered public
records under the Washington Public Records Act, chapter 42.56 RCW and subject to public
disclosure.
Signature of Petitioner:
Date of Signature:
click to sign
signature
click to edit
click to sign
signature
click to edit
Revised 01/19/2018 8
WAIVER AND AUTHORIZATION TO RELEASE INFORMATION
To Whom It May Concern:
I authorize you to furnish the Office of the Governor of Washington State with any and all
information that you have concerning me, my work record, my reputation, my medical records,
my psychological records, my military service records, my criminal history, and my financial
status. Information of a confidential or privileged nature may be included.
I waive any and all privacy rights I may have and I hereby release you, your organization, and
others from any liability or damage which may result from furnishing the information requested.
A photocopy of this authorization shall be as valid as the original.
To be completed by the applicant:
(Print name) (Signature) (Date)
(Other names you have been known by, including prior marriage or nickname.)
(Address) (City) (State) (Zip)
(Phone) (Social Security Number)
(Date of Birth) (Driver’s License Number)
(Prison Number)
THIS ORIGINAL, SIGNED PAGE OF THE
PETITION MUST BE
SUBMITTED VIA U.S. MAIL TO:
Washington State Clemency and Pardons Board
Office of the Attorney General
PO Box 40116
Olympia, Washington 98504-0116
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

PETITION FOR REPRIEVE, COMMUTATION, OR PARDON (Washington)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 11 May 2022

Message

View Audit Log
Print With Audit Log
Duplicate Document