Form Writ Habeas Corpus – Fill Out and Use This PDF

IN THE SUPERIOR COURT OF

STATE OF GEORGIA

,

Petitioner

,Civil Action No.

Inmate Number

vs.

,Habeas Corpus

Warden

Respondent

(Name of Institution where you are now located)

APPLICATION FOR WRIT OF HABEAS CORPUS

PART I: BACKGROUND INFORMATION ON YOUR CONVICTION

1.Name, county, and court which entered the judgment of conviction under attack :

2.Date of conviction :

3.Length of sentence(s) :

4.Were you sentenced on more than one count of an indictment, or on more than one indictment, in the

	same court and at the same time? Γ Yes			Γ No
5.	Name of offense(s). List all counts :
6.	What was your plea? Please check one :
	Γ	Guilty
	Γ Guilty but mentally ill
	Γ	Nolo contendere
	Γ	Not guilty

If you entered a guilty plea to one count or indictment, and a not guilty or nolo contendere plea to another count or indictment, give details :

7.Kind of trial. Please check one :

ΓJury

ΓJudge only

8.	Did you testify at the trial? Γ Yes	Γ No
9.	Did you appeal from the conviction?	Γ Yes	Γ No

10.If you did appeal, answer the following :

Name of appellate court to which you appealed : Result of appeal :

Date of result :

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11.Other than a direct appeal from the judgment of conviction and sentence, have you previously filed any petitions, applications, or motions with respect to this conviction in any state or federal court?

Γ Yes

Γ No

12.If your answer to 11 was “Yes”, give the following information : (Note: if more than three petitions, please use a separate sheet of paper and use the same format to list them.)

A.Name of court and case number : What kind of case or action was this?

All grounds raised (attach extra sheet of paper if necessary) :

Did a judge hear the case? Γ Yes Γ No				Did witnesses testify? Γ Yes Γ No
Name of Judge :
Result :
Date of result :

B.As to any second petition, application or motion, give the same information. Name of court and case number :

What kind of case or action was this?

All grounds raised (attach extra sheet of paper if necessary) :

Did a judge hear the case? Γ Yes Γ No				Did witnesses testify? Γ Yes Γ No
Name of Judge :
Result :
Date of result :

C.As to any third petition, application or motion, give the same information. Name of court and case number :

What kind of case or action was this?

All grounds raised (attach extra sheet of paper if necessary) :

Did a judge hear the case? Γ Yes Γ No				Did witnesses testify? Γ Yes Γ No
Name of Judge :
Result :
Date of result :

D.Did you appeal to the Georgia Supreme Court or the Georgia Court of Appeals from the result taken on any petition, application or motion listed above?

First petition, application or motion :	Γ Yes	Γ No
Second petition, application or motion:	Γ Yes	Γ No
Third petition, application or motion:	Γ Yes	Γ No

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E.If you did not appeal from the denial of relief on any petition, application or motion, explain briefly why you did not :

F.If you appealed to the highest state court having jurisdiction, did you file a petition for certiorari in the United States Supreme Court to review the denial of your petition by the Georgia Supreme Court

or the Georgia Court of Appeals? Γ Yes

Γ No

13.Do you have any petition or appeal now pending in any court, either state or federal, as to the conviction

under attack? Γ Yes

Γ No

14.Give the name and address, if known, of each attorney who represented you in the following stages of the judgment attacked herein :

At preliminary hearing :

At arraignment and plea :

At trial :

At sentencing :

On appeal :

In any post-conviction proceeding :

On appeal from any adverse ruling in a post-conviction proceeding :

15.Do you have any other sentence, either state or federal, to serve after you complete the sentence imposed

by the conviction under attack? Γ Yes

Γ No

If so, give the name and location of the court(s) which imposed any other sentence :

And give the date and length of any other sentence to be served :

Have you filed, or do you contemplate filing, any petition attacking the judgment(s) which imposed any

other sentence? Γ Yes	Γ No

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PART II: STATEMENT OF YOUR CLAIMS

State concisely every ground on which you now claim that you are being held unlawfully. Summarize briefly the facts supporting each ground. If necessary, you may attach pages stating additional grounds and facts supporting same.

1.

GROUND ONE :

SUPPORTING FACTS. (Tell your story briefly without citing cases or law) :

2.

GROUND TWO :

SUPPORTING FACTS. (Tell your story briefly without citing cases or law) :

3.

GROUND THREE:

SUPPORTING FACTS. (Tell your story briefly without citing cases or law) :

4.

GROUND FOUR:

SUPPORTING FACTS. (Tell your story briefly without citing cases or law) :

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PART III: OTHER CLAIMS NOT PRESENTED TO A COURT BEFORE THIS

If any of the grounds listed in PART II were not previously presented in any other court, state or federal, state briefly what grounds were not so presented, and give your reasons for not presenting them:

Wherefore, petitioner prays that the Court grant relief to which the petitioner may be entitled in this proceeding.

Date

Signature and Address of Petitioner’s

Attorney (if any attorney)

I declare ( or certify, verify, or state) under penalty of perjury that the foregoing statements made in this Application for Writ of Habeas Corpus are true and correct.

Executed on

Date

Please note that under O .C.G.A.§9-14-45 service of a petition of habeascorpus shall be made upon the person having custody of the petitioner. If you are being detained under the custody of the Georgia D epartment of Corrections, an additional copy of the petition must be served on the Attorney General of Georgia. If you are being detained under the custody of some authority other than the Georgia D epartment of Corrections, an additional copy of the petition must be served upon the district attorney of the county in which the petition is filed. Service upon the Attorney General or the district attorney may be had by mailing a copy of the petition and a proper certificate of service.

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