Pardon Application Form – Fill Out and Use This PDF

Department of Public Safety and Correctional Services

REMINDER: The submission of any false information renders

the applicant ineligible for pardon consideration.

Application for Pardon

Please read all questions and instructions carefully before completing the application. Type or print the answers in ink. Each question must be answered fully, truthfully, and accurately. If the space for any answer is insufficient, you may complete the answer on a separate sheet of paper and attach it to the application. The submission of any false information renders the applicant ineligible for pardon consideration.

To The Governor:

The undersigned applicant prays for a pardon and in support thereof states as follows:

1.Full name: ____________________________________________________________________

FirstMiddle Last

Address: ______________________________________________________________________

Number StreetCityStateZip Code

Telephone Number: ___________________ Social Security Number: ___________________

(area code)

Date and place of birth: _________________________________________________________

Sex: ___________ Height: ___________ Weight: ___________ Race: ___________________

State in full every other name by which you have been known, including the name under which you were convicted, the reason for your use of another name, and the dates during which you were so known (i.e., include your maiden name, name by a former marriage, aliases, and nicknames).

______________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________

If yes, state the date you applied for pardon and the date you were notified of the final disposition of the petition.

______________________________________________________________________________

______________________________________________________________________________

2.Driver’s License #: ____________________________________ State issued: _____________

For each jurisdiction in which you held a driver’s license at any time, attach a CERTIFIED COPY OF YOUR ENTIRE DRIVING HISTORY FROM THE MOTOR VEHICLE AUTHORITY. Since many jurisdictions issue a limited history unless specifically asked to do otherwise, you should take whatever steps are required to obtain a complete driving history.

1

Prior and Subsequent Criminal History

Under the Rules Governing Applications for Pardon, the applicant must satisfy the following guidelines before becoming eligible to apply for a pardon:

1.The Applicant shall not be incarcerated.

2.Misdemeanants must have been crime-free from the date of sentence, released from incarceration, or released from parole or probation, whichever last occurred, for a period of five (5) years.

3.Except as provided in paragraph #4, felons must have been crime-free from the date of sentence, released from incarceration, or released from parole or probation, whichever last occurred for ten (10) years except, however, the Parole Commission may, at its discretion and in specific instances, consider cases in which only seven (7) years have elapsed.

4.Felons convicted of crimes of violence as defined in §5-101 of the Public Safety Article and felons convicted of controlled dangerous substance violations must have been crime-free from the date of sentence, released from incarceration, or released from parole or probation, whichever last occurred, for twenty (20) years except, however, the Parole Commission may, at its discretion and in specific instances, consider cases in which only fifteen (15) years have elapsed.

3.List all felony and misdemeanor convictions, and all traffic convictions, which involved drugs or alcohol (convictions in other States and/or Nations should also be included).

A CERTIFIED COPY OF THE JUDGMENT AND SENTENCE ON EACH CASE MUST BE ATTACHED TO YOUR APPLICATION. Certified copies can be obtained from the court clerk in the county in which you were convicted.

2

4.If you appealed any of your convictions or sentences, please provide the date of the decision(s) by the Court. Also provide citations to any published judicial opinion(s), and a copy of any unpublished opinion(s), if available.

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

5.List your institutional incarceration history, if applicable.

6.List your parole and/or probation history, if applicable.

3

7.Provide a complete and detailed account of the offense(s) for which you received a conviction (or received convictions).

You are expected to describe in your own words the relevant factual circumstances of the offense(s). Do not simply repeat the description of the offense contained in the indictment or the pre-sentence report, or rely on criminal code citations alone. If the conviction(s) resulted from a plea agreement (or plea agreements), you should describe the full extent of your involvement in the criminal conduct, in addition to the charge(s) to which you pled guilty. If you need more space, use a separate sheet of paper.

______________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

4