When embarking on the path toward a second chance or a fresh start, understanding the New Jersey Executive Clemency form is crucial. This form serves as the gateway for individuals seeking to lighten the burden of their past, offering options such as pardons, remission of fines, or commutation of sentences. Applicants must fill out the form meticulously, answering all questions thoroughly and legibly, with additional pages attached if necessary. For those incarcerated, the form's submission goes through the correctional facility's administration, whereas all others mail their petitions directly to the New Jersey State Parole Board's Clemency Unit. It's noteworthy that supplementing the petition with relevant documents, although not mandatory, could be beneficial. The form inquires deeply into the petitioner's personal history, including their legal background, familial ties, education, employment history, and even voluntary affiliations, painting a comprehensive picture of the individual behind the petition. This detailed approach underscores the state's commitment to considering the full spectrum of an applicant's life and circumstances in its clemency decisions. With every field meticulously designed to capture the essence of the petitioner’s life, ambitions, and character, the form stands not just as a procedural step, but as a bridge towards potential redemption and societal reintegration.
| Question | Answer |
|---|---|
| Form Name | New Jersey Executive Clemency Form |
| Form Length | 12 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 3 min |
| Other names | where new jersey petition for expungement, new jersey petition, how new jersey petition for guardianship, clemency petition form |
STATE OF NEW JERSEY
PETITION FOR EXECUTIVE CLEMENCY
INSTRUCTIONS: All questions must be answered in full and printed legibly in ink or typed. In the event that this form does not provide sufficient space for any answer, attach additional sheets and number your answer accordingly. If you are confined in a correctional facility, this form must be completed and forwarded to the Administrator of the correctional facility where you are confined. In all other cases the completed petition should be mailed to:
New Jersey State Parole Board
Attn: Clemency Unit
P.O. Box 862
Trenton, New Jersey 08625
NOTE: It would be helpful if you support this petition with documentation (i.e.; copies of high school diploma, college transcripts, marriage license, proof of employment, proof of citizenship, if applicable etc.); however, it is not necessary that you provide these documents.
Applicant Name:
Address:
Telephone #:
If you are represented by an attorney or other party, please indicate to whom all communications relating to this petition should be addressed.
Attorney Name:
Address:
Telephone #:
1.Type of Executive Clemency sought by applicant (check one below):
Pardon |
Remission of Fine |
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Commutation of Sentence |
Other |
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2.List any other names by which you have been known:
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3.What is your reason for seeking clemency?
4.State briefly why you believe you should be granted clemency:
5. |
Date of Birth: |
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SBI No.: |
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Place of Birth: |
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Driver's License No.: |
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County of Birth: |
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Social Security No.: |
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6.If you were not born in the United States, complete below. When did you first enter the United States?
Port of entry:
Under what name did you enter?
Are you a naturalized citizen of the United States?
Yes |
Date of Naturalization: |
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No |
Give alien registration number: |
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Are you presently under an order for deportation or are deportation
proceedings pending? |
Yes |
No |
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Are you under an immigration detainer? |
Yes |
No |
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7.For each member of your family give the following information:
Name
(if deceased, give age at death)
Address
Occupation
Father
Mother
Brothers
Sisters
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8. |
Were your parents ever separated or divorced? |
Yes |
No |
9.Please indicate the highest level of education you attended and the dates.
School
Date
Attended
Date
Completed
10. Were you ever married? (include civil union) |
Yes |
No |
(If "yes", please provide) |
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Name Used
Maiden Name
Date Married/
Civil Union
Place of Marriage/
Civil Union
Did any marriage or civil union result in annulment, legal separation, or divorce?
Yes No
(If "yes", please provide)
Name of Court
Location of Court
Date of Decree
Type of Decree
Conditions of
Decree
11. Do you have children? |
Yes |
No If yes, how many? _________ |
Give the following information about your children and any others who are dependent upon you for support:
Name
Address
Date of
Birth
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12.List each job you have held and give the following information regarding each position:
Employer:
Date Employed: |
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Position Held: |
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Salary: |
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Reason for Leaving: |
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Employer: |
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Date Employed: |
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Position Held: |
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Salary: |
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Reason for Leaving: |
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Employer: |
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Date Employed: |
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Position Held: |
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Salary: |
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Reason for Leaving: |
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(Please use a separate sheet of paper for additional employers)
13. Religious affiliation: |
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Name of Church: |
14.Provide names and addresses of any social clubs, unions, fraternal groups, or other community organizations to which you belong; include dates of participation.
15. Have you ever served in the United States Armed Forces? |
Yes |
No |
(If "yes", please provide)
What branch did you serve?
Date and Place of entry:
Serial, service or identification number:
Highest rank:
Discharge: |
Honorable |
Dishonorable |
General |
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Bad Conduct |
Other (explain) |
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Date of discharge: |
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(Provide official discharge documents) |
Do you have a disability that is recognized by the Veteran's Administration?
Yes No
If you do, describe the degree of your disability and indicate amount of financial benefit received per month:
16.Record of arrests: (List each time you were arrested and whether a conviction resulted. If you are uncertain of any details, your statement to that effect may be grounds for rejection of this petition for falsification. If possible, provide any arrest reports or court documents [i.e.,
Arrest Date: |
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Date of Sentence: |
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Location of Court: |
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Crime(s): |
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Sentence:
(Confinement, Probation, Fine, etc.)
Circumstances of Crime:
Arrest Date: |
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Date of Sentence: |
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Location of Court: |
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Crime(s): |
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Sentence:
(Confinement, Probation, Fine, etc.)
Circumstances of Crime:
Arrest Date: |
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Date of Sentence: |
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Location of Court: |
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Crime(s): |
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Sentence:
(Confinement, Probation, Fine, etc.)
Circumstances of Crime:
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Arrest Date: |
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Date of Sentence: |
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Location of Court: |
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Crime(s): |
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Sentence:
(Confinement, Probation, Fine, etc.)
Circumstances of Crime:
Arrest Date: |
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Date of Sentence: |
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Location of Court: |
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Crime(s): |
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Sentence:
(Confinement, Probation, Fine, etc.)
Circumstances of Crime:
(Please use separate sheets of paper for additional arrests/convictions)
17.List each instance of incarceration in a correctional facility:
Name of Facility
Location of Facility
Date
Entered
Date
Released
18.Have you ever appealed the conviction or sentence for which you are seeking
clemency? |
Yes |
No |
(If "yes", please provide)
Name of Court
Docket Number
Date of Disposition
of Appeal
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Are any appeals currently pending? |
Yes |
No |
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(If "yes", please provide) |
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What jurisdiction? |
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Have you ever filed a motion for post conviction relief? |
Yes |
No |
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(If "yes", please provide) |
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Disposition
Date of Disposition
Have you applied for an expungement? |
Yes |
No |
(If "yes", please provide)
Disposition
Date of Disposition
19.List each instance of parole or probation including (PTI)
Type of Supervision
(Parole, Probation, PT, CD)
Date Supervision
Began
District
Office
Date of
Discharge
List each instance of revocation of parole or probation:
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20.Have you ever had a court issue a restraining order against you for a domestic
Yes |
No |
(If "yes". please provide)
Details of restraining order:
21. Do you have any open, pending court matters? |
Yes |
No |
(If "yes". please provide)
Court
(Superior or Municipal)
Offense
Date of
Arrest
22.Have you ever been hospitalized for treatment of a psychological disorder?
Yes No
(If "yes". please provide)
Institution
Date Entered
Date Released
23.Please provide a detailed history of your alcohol and/or drug use.
Substance(s) of choice: Frequency of use:
Age started:
Amount of money spent on use: |
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Ever sold drugs? |
Yes |
No |
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Ever charged with Driving Under the Influence? |
Yes |
No |
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(If "yes". please provide) Disposition:
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Have you ever received treatment for alcohol and/or drug addiction?
Yes No
(If "yes", please provide information for each treatment you experienced) Type of treatment: (Check all that apply)
Inpatient |
Outpatient |
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Narcotics Anonymous (NA) |
Alcohol Anonymous (AA) |
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Name of treatment facility: |
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Date entered: |
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Location: |
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Date discharged: |
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Number of days in treatment: |
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Reason for discharge: |
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(Please provide additional pages for each instance of treatment)
Did you successfully complete the program? |
Yes |
No |
(If "no", please indicate reason for failure to complete the program)
Explanation:
Did the court ever order treatment? |
Yes |
No |
(If "yes", please provide for each order)
Court
Date
24.Have you ever returned to active drug or alcohol use after attending Alcoholics Anonymous/Narcotics Anonymous or after having received professional treatment?
Yes No
(If "yes", please provide)
Details of relapse:
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Have you ever participated in any alcohol or drug treatment programs during
your present confinement? |
Yes |
No |
(If "yes", please provide) |
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Name of Program
Dates of Participation
If possible, provide copy of certificate of completion to all programs.
25.List any other institutional programs you are currently participating in or completed during your present confinement:
26.Have you ever previously applied to the Governor of New Jersey for Executive Clemency?
Yes No
(If "yes", please provide)
Date of
Application
Type of Clemency
Sought
Disposition
Date of
Disposition
27.This petition is subject to a complete investigation. However, the petitioner has the right to request that the State refrain from contacting individuals such as employers or others. Do you desire any such limitation to be placed on the
investigation? |
Yes |
No |
(If "yes", please provide)
List of those not to be contacted:
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If this petition is for a Pardon, attach testimonials (letters of support) addressed to the Governor from at least two (2) persons who have knowledge of your community adjustment during the past two (2) years and, if possible, who are aware of the crime(s) for which clemency is sought; or attach a statement explaining why you cannot furnish such testimonials. If this petition is for a Commutation of Sentence, testimonials are not required.
Petitioner's Signature: |
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Date: |
Sworn and subscribed to before me this
day of |
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20 |
at
in the County of
State of
(Notary Public or other authorized to take oaths)
NOTE: It is your responsibility to notify our office of any changes in your address or telephone number.
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State of New Jersey
CHRIS CHRISTIE |
NEW JERSEY STATE PAROLE BOARD |
JAMES T. PLOUSIS |
GOVERNOR |
P.O. BOX 862 |
CHAIRMAN |
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TRENTON, NEW JERSEY 08625 |
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KIM GUADAGNO |
TELEPHONE NUMBER: (609) |
SAMUEL J. PLUMERI, JR. |
LT. GOVERNOR |
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hereby authorize any law enforcement
agency, insurance company, current or former employer(s), State and Federal income tax bureaus, educational institution, or any other named agency to furnish the New Jersey State Parole Board with any requested information and/or documents pertaining to myself, for the purpose of completing a confidential community investigation which is required for processing my application for Executive Clemency.
____________________________________ |
______________ |
Applicant Signature |
Date |
____________________________________ |
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Applicant Identification No. (SS#; SBI #; etc.) |
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c:Copy for File Copy to Provider
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