Offense(s) For Which Commutation Is Sought
_____________________________________________________________________________________________
(State specific offense(s); provide citation of statute(s) violated, if known)
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
I was sentenced on ___________, ________ to imprisonment for ________________________, to pay
(month/day) (year) (length of sentence)
a fine of $ ___________________, restitution of $ ____________________, and to
(do not include special assessment)
supervised release or special parole for __________________, and/or to probation for
___________________________.
I was ____________ years of age when the offense was committed.
(length of sentence)
3. I began service of the sentence of imprisonment on ________, ________, and I am projected to
(month/day) (year)
be released from confinement on ____________, __________.
(month/day) (year)
Are you eligible for parole?
If yes, indicate the date when you became eligible for release, and state whether your application for parole was
granted or denied
_____________________________________________________________________________________________
Have you paid in full any fine or restitution imposed on you?
If the fine or restitution has not been paid in full, state the remaining balance.
_____________________________________________________________________________________________
4. Did you appeal your conviction or sentence to the United States Court of
Appeals?
Is your appeal concluded?
If yes, indicate whether your conviction or sentence was affirmed or reversed, the date of the decision, and the
citation(s) to any published court opinions. Provide copies of any unpublished court decisions concerning such
appeals, if they are available to you.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Did you seek review by the Supreme Court?
Is your appeal concluded?
If yes, indicate whether your petition was granted or denied and the date of the decision.
______________________________________________________________________________
______________________________________________________________________________
____________________________________________________________________________________
Petition for Commutation of Sentence
age 2