Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_06-cv-02926/USCOURTS-azd-2_06-cv-02926-0/pdf.json

Nature of Suit Code: 530
Nature of Suit: Prisoner Petitions - Habeas Corpus
Cause of Action: 28:2254 Petition for Writ of Habeas Corpus (State)

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JDDL

WO SVK

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Richard Lee McCuin, 

Plaintiff,

v.

Joseph M. Arpaio, et al.,

Respondents. 

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No. CV 06-2926-PHX-SMM (DKD)

ORDER

Petitioner Richard Lee McCuin, confined in the Maricopa County Lower Buckeye

Jail, has filed a pro se Writ of Habeas Corpus pursuant to 28 U.S.C. § 2254. Petitioner has

not filed a Request to Proceed In Forma Pauperis, nor has he paid the filing fee. Petitioner

has also not filed his Petition on the court-approved form. The Court will give Petitioner 30

days to pay the fee or file a completed Application to Proceed In Forma Pauperis and also

to file an amended Petition using the court-approved form.

I. Failure to Pay Filing Fee or File an Application to Proceed In Forma Pauperis

 Rule 3.5(b) of the Local Rules of Civil Procedure requires that “[i]f a habeas corpus

petitioner desires to prosecute the petition in forma pauperis, the petitioner shall file an

application to proceed [in forma pauperis] on a form approved by the Court, accompanied

by a certification of the warden or other appropriate officer of the institution in which the

petitioner is confined as to the amount of money or securities on deposit to the petitioner’s

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The $5.00 filing fee is set by 28 U.S.C. § 1914(a).

JDDL - 2 -

credit.” Rule 3.5(b) also requires payment of the $5.001 filing fee if a petitioner has in excess

of $25.00 in his inmate account. Id. 

Because Petitioner has not paid the $5.00 filing fee or filed an Application to Proceed

In Forma Pauperis, Petitioner will be given 30 days from the filing date of this Order to

submit a properly executed and certified Application to Proceed In Forma Pauperis, using

the form included with this Order, or pay the $5.00 filing fee.

II. Failure to Use the Court-Approved Form

 Under this Court’s local rule, Petitioner must use the court-approved form when he

files a pro se petition pursuant to 28 U.S.C. § 2254. LRCiv 3.5(a). Petitioner has not used

the court-approved form. 

The Court may, in its discretion, forgo the requirement that a Petitioner use a courtapproved form. See LRCiv 3.5(a). In this case, however, the Court will require use of the

court-approved form because Petitioner’s document does not substantially comply with the

court-approved form for filing a § 2254 proceeding. Because the document Petitioner used

is inadequate for a § 2254 proceeding, Petitioner will be given 30 days to file an amended

petition. Petitioner may raise only one claim for relief under each ground.

III. Amendment

Any amended petition must be submitted on the court-approved form and signed

under penalty of perjury. In particular, Petitioner must separately list each ground for relief

and state the facts supporting each ground. Petitioner is advised that the amended petition

must be retyped or rewritten in its entirety on the court-approved form and may not

incorporate any part of the original Petition by reference. Any amended petition submitted

by Petitioner should be clearly designated as an “Amended Petition” on the face of the

document. To assist Petitioner, the Court will direct the Clerk of Court to send Petitioner the

current, court-approved form for filing a § 2254 action.

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Petitioner is further advised that an amended § 2254 petition supersedes the original

Petition. See Ferdik v. Bonzelet, 963 F.2d 1258, 1262 (9th Cir. 1992); Hal Roach Studios

v. Richard Feiner & Co., 896 F.2d 1542, 1546 (9th Cir. 1990). After amendment, the

original pleading is treated as nonexistent. Ferdik, 963 F.2d at 1262. Thus, grounds for

relief alleged in the original Petition which are not alleged in the amended petition are

waived. See King v. Atiyeh, 814 F.2d 565, 567 (9th Cir. 1987).

IV. Warnings

A. Address Changes

Petitioner must file and serve a notice of a change of address 10 days before his move

is effective, if practicable. See LRCiv 83.3(d). Petitioner must not include a motion for

other relief with his notice of change of address. 

B. Copies

Petitioner must submit an additional copy of every original motion or other document

filed for use by the District Judge or Magistrate Judge to whom the case is assigned. See

LRCiv 5.4. Failure to comply with this requirement may result in the motion or document

being stricken without further notice to Petitioner.

C. Possible Dismissal

Petitioner is warned that if he fails to timely comply with every provision of this

Order, including these warnings, this Petition will be dismissed without further notice. See

Ferdik, 963 F.2d at 1260-61 (a district court may dismiss an action for failure to comply with

any order of the Court).

IT IS ORDERED:

(1) Within 30 days from the filing date of this Order, Petitioner must submit a 

properly executed and certified Application to Proceed In Forma Pauperis, using the form

included with this Order, or pay the $5.00 filing fee.

(2) Within 30 days from the filing date of this Order, Petitioner must file an 

amended Petition, using the form included with this Order.

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(3) The Clerk of Court must enter a judgment of dismissal without prejudice of 

this action, without further notice to Petitioner, if within 30 days from the filing date of this

Order, Petitioner fails to submit a properly executed and certified Application to Proceed In

Forma Pauperis or pay the $5.00 filing fee or he fails to file an amended Petition.

(4) The Clerk of Court must provide Petitioner with a current, court-approved 

form titled "Application to Proceed In Forma Pauperis By A Prisoner (Habeas)” and the

current, court-approved form for filing a Writ of Habeas Corpus pursuant to 28 U.S.C. 

§ 2254.

DATED this 27th day of December, 2006.

Case 2:06-cv-02926-SMM--DKD Document 3 Filed 12/28/06 Page 4 of 20
98-2254ins

Revised 12/3/04 1

INFORMATION AND INSTRUCTIONS FOR FILING A PETITION FOR 

WRIT OF HABEAS CORPUS BY A PERSON IN STATE CUSTODY

PURSUANT TO 28 U.S.C. § 2254 IN THE UNITED STATES

 DISTRICT COURT FOR THE DISTRICT OF ARIZONA

I. General Information About the Habeas Corpus Form:

A. The Form. The petition for writ of habeas corpus by a person in state custody form is

designed to help prisoners prepare a petition challenging their custody on the grounds that their

state conviction or sentence violates the United States Constitution or other federal law. Local

Rule of Civil Procedure 3.5(a) requires that habeas corpus petitions be filed on the courtapproved form. Your petition must be typewritten or legibly handwritten. All questions must

be answered clearly and concisely in the appropriate space on the form. If needed, you may

attach additional pages. The form, however, must be completely filled in to the extent

applicable. This form should not be used in death penalty cases.

B. Your Signature. The petition must be signed by the petitioner under penalty of perjury. Any

false statement of a material fact may serve as the basis for prosecution and conviction for

perjury. Your signature must be an original signature, not a photocopy.

C. The Filing Fee. Your petition for writ of habeas corpus must be accompanied by the $5.00

filing fee (checks or money orders should be made payable to the Clerk of the Court). If you

are unable to pay the filing fee when the petition is filed, you may request permission to proceed

in forma pauperis by completing and signing the Application to Proceed In Forma Pauperis

provided with the petition form. You must have an official at the prison or jail complete the

certificate at the bottom of the application form. If the amount of money in your prison account

exceeds $25.00, you must pay the $5.00 filing fee. See LRCiv 3.5(b).

D. Court Divisions. If you are challenging a state judgment of conviction entered in Maricopa,

Pinal, Yuma, La Paz, or Gila county, you should file your petition in the Phoenix Division of

the court. If you are challenging a state judgment of conviction entered in Apache, Navajo,

Coconino, Mohave, or Yavapai county, you should file your petition in the Prescott Division

of the court. If you are challenging a state judgment of conviction entered in Pima, Cochise,

Santa Cruz, Graham, or Greenlee county, you should file your petition in the Tucson Division

of the court. See LRCiv 5.1(b) and 77.1(a). 

You should mail THE ORIGINAL AND TWO COPIES of your petition with the $5.00

filing fee or the application to proceed in forma pauperis to:

Phoenix & Prescott Divisions: OR Tucson Division:

U.S. District Court Clerk U.S. District Court Clerk

U.S. Courthouse, Suite 321 U.S. Courthouse, Suite 1500

401 West Washington Street, SPC 10 405 West Congress Street

Phoenix, Arizona 85003-2119 Tucson, Arizona 85701-5010

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E. Certificate of Service on Respondents. You must furnish the respondents or their attorney

with a copy of any document you submit to the court (except the initial petition and application

to proceed in forma pauperis). Pursuant to Rules 5(a) and (d) of the Federal Rules of Civil

Procedure, each original document (except the initial petition and application for leave to

proceed in forma pauperis) must include a certificate of service on the last page of the document

stating the date a copy of the document was mailed to the respondents or their attorney and the

address to which it was mailed. Any document received by the court which does not include

a certificate of service may be stricken. A certificate of service should be in the following form:

I hereby certify that a copy of the foregoing document was mailed

this day of (month) , (year) , to:

Name: 

Address: 

 Attorney for Defendant(s)/Respondent(s)

 

(Signature)

F. Original and Judge's Copy. You must file an original plus two copies of your petition. After

the petition is filed, you must furnish an original and one copy of any other document submitted

to the court. You must furnish one additional copy to the clerk if you wish to have a filestamped copy of the document returned to you. All copies must be identical to the original.

G. Exhibits. You should attach a copy of all final state court written decisions and all written

decisions by the Ninth Circuit Court of Appeals regarding the conviction you are challenging.

You should not submit any other exhibits with the petition. Instead, the relevant information

should be paraphrased in the petition.

H. Change of Address. You must immediately notify the clerk and the opposing party or their

attorney in writing of any change in your mailing address. Failure to notify the court of any

change in your mailing address may result in the dismissal of your case.

I. Amended Petition. If you need to change any of the information in the initial petition, you must

file an amended petition. The amended petition must be written on the court-approved petition

for habeas corpus form. Local Rule of Civil Procedure 15.1(a)(2) prohibits any amended pleading

from referencing any prior pleading. Further, any grounds not included in the amended petition

are considered dismissed.

J. Letters and Motions. It is generally inappropriate to write a letter to any of the District

Judges, Magistrates Judges, or the staff of any of the judicial officers. The appropriate way to

communicate with these persons is by filing a written pleading or motion. 

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II. Completing the Habeas Corpus Petition Form:

HEADING:

1. Your Name and Address. Print your name, prison or jail inmate number, and mailing

address on the lines provided in the upper left hand corner of the form.

2. Petitioner. Print your full name on the first line of the caption. 

3. Respondent. Print the name of the director of the department of corrections, or the

warden of the institution where you are confined, or some other official who has

responsibility for your current custody.

4. Additional Respondent. Print the name of the state where the judgment of conviction

you are challenging was entered on the blank line below the heading “THE ATTORNEY

GENERAL OF THE STATE OF.” 

PART A. JUDGMENT OF CONVICTION:

Only one state judgment of conviction may be challenged in a single petition for writ of

habeas corpus. Multiple counts which resulted in a single judgment of conviction may be

challenged in the same petition for writ of habeas corpus. If you wish to challenge more than

one judgment, however, you must file separate habeas corpus petitions for each judgment. Print

all of the requested information regarding your judgment of conviction and sentence on the

spaces provided.

Part B. APPEALS:

Answer each of the questions regarding your direct appeals in the state courts. If you

filed appeals in the state courts, you must provide the requested information for each level of

appeal on the spaces provided. Attach a copy of all written decisions on your appeal.

Part C. FIRST STATE POST-CONVICTION PROCEEDINGS:

Most states provide a specific method for challenging a conviction in the state courts

after direct appeals have been completed. In Arizona the method is a petition for postconviction relief pursuant to Rule 32 of the Arizona Rules of Criminal Procedure. Answer each

of the three questions regarding any first post-conviction relief proceedings you had in the state

courts. If you sought review of your petition in the state appellate courts, you must provide the

requested information for each level of appeal on the spaces provided. Attach a copy of all

written decisions on your petition and appeal.

Part D. SECOND STATE POST-CONVICTION PROCEEDINGS:

Answer each of the three questions regarding any second post-conviction relief

proceedings you had in the state courts. If you sought review of your second petition in the

state appellate courts, you must provide the requested information for each level of appeal on

the spaces provided. Attach a copy of all written decisions on your second petition and appeal.

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Part E. OTHER STATE PROCEEDINGS:

The Arizona courts normally permit a defendant to challenge his or her conviction or

sentence only by filing a direct appeal or a Rule 32 petition for post-conviction relief. There

may, however, be a few very narrow exceptions that permit a challenge by filing a “special

action” or a habeas corpus petition in the state courts. Answer each of the three questions

regarding any such proceedings you had in the state courts. Attach a copy of all written

decisions on these proceedings. 

Part F. FEDERAL PROCEEDINGS:

If this is not your first federal habeas corpus petition challenging this conviction, answer

each of the seven questions regarding your prior federal petition. If your previous federal

petition was denied, you must obtain permission from the Ninth Circuit Court of Appeals before

you may file a second petition in the federal courts. If the court of appeals has granted you

permission to file a successive petition, attach a copy of the court’s written decision.

Part G. PENDING PROCEEDINGS:

If you have an appeal, petition, or other proceedings currently pending regarding the

conviction you are challenging in this petition, answer each of the three questions in the spaces

provided. Ordinarily, you may not file a federal petition for writ of habeas corpus if you have

an appeal still pending in the state courts.

Part H. REPRESENTATION:

Print the name of the attorney who represented you at each stage of your state court

criminal proceedings. If you represented yourself at any stage, check the box marked “Pro Se.”

Part I. OTHER SENTENCES:

If you have any other sentences to serve aside from the sentence imposed by the

judgment you are challenging in this petition, answer each of the four questions regarding your

other convictions and sentences.

CLAIMS FOR RELIEF:

State concisely every ground for which you claim that your conviction or sentence

violates the United States Constitution or other federal law. Your claims should not be based

on state law. Summarize briefly the facts supporting each ground. If necessary, you may attach

pages stating additional grounds and supporting facts. You must raise all grounds for relief

that relate to this conviction or sentence. Any grounds not raised in this petition will likely be

barred from being raised in any subsequent federal action.

The following list of the most frequently raised grounds for relief in habeas corpus

proceedings is provided for your information only. You may raise any other federal grounds

if you have exhausted all your state court remedies with respect to those grounds.

1. Conviction obtained by a plea of guilty which was unlawfully induced or not made

voluntarily with the understanding of the nature of the charge or the consequences of the

plea.

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2. Conviction obtained by use of a coerced confession.

3. Conviction obtained by use of evidence gained pursuant to an unconstitutional search

and seizure (where the state did not provide a full and fair hearing on the Fourth

Amendment claim).

4. Conviction obtained by use of evidence gained pursuant to an unlawful arrest (where

the state did not provide a full and fair hearing on the Fourth Amendment claim).

5. Conviction obtained by a violation of the privilege against self-incrimination.

6. Conviction obtained by the unconstitutional failure of the prosecution to disclose

evidence favorable to the defendant.

7. Conviction obtained by a violation of the protection against double jeopardy.

8. Conviction obtained by action of a grand or petit jury which was unconstitutionally

selected or impaneled.

9. Denial of effective assistance of trial counsel or counsel on direct appeal in the state

courts.

10. Denial of right of appeal.

Parts G-M GROUNDS:

The form includes space for only four grounds. If you are alleging more than four grounds,

answer all of the questions for each additional ground on a separate page.

1. You must identify which constitutional right or other federal law was violated. You

may allege the violation of only one federal right per ground. Your claim should not

be based on state law.

2. Supporting facts. After you have identified which federal right was violated, you

need to state the supporting facts. Be as specific as possible. Tell your story briefly

without citing cases or law.

3. Exhaustion. In order to proceed in federal court, you ordinarily must exhaust the

remedies available to you in the state courts as to each claim on which you request

action by the federal court. If you did not fairly present each of your grounds to the

state’s highest court, your petition may be dismissed. If you did not present one or more

of your grounds to the state’s highest court, explain why you did not.

SIGNATURE:

You must sign your name and print the date you signed the petition. Your signature

must be an original signature, not a photocopy. Any false statement of a material fact may serve

as the basis for prosecution and conviction for perjury.

FINAL NOTE

You should follow these instructions carefully. Failure to do so may result in your

petition being stricken or dismissed by the court. All questions must be answered concisely

in the proper space on the form. If needed, you may attach additional pages. The form,

however, must be completely filled in to the extent applicable. If you attach additional pages,

be sure to identify which section of the petition is being continued and number all pages.

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98-2254

Revised 6/98 1 530

Name and Prisoner/Booking Number

Place of Confinement

Mailing Address

City, State, Zip Code

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

 , )

(Full Name of Petitioner) )

Petitioner, )

)

vs. ) CASE NO. 

) (To be supplied by the Clerk)

 , )

(Name of Warden, Superintendent, Jailor or )

authorized person having custody of Petitioner) )

) PETITION FOR WRIT OF HABEAS CORPUS

Respondent, ) BY A PERSON IN STATE CUSTODY

and ) PURSUANT TO 28 U.S.C. § 2254

THE ATTORNEY GENERAL OF THE STATE OF ) (NON-DEATH PENALTY)

)

, )

Additional Respondent. )

)

A. JUDGMENT OF CONVICTION

1. Name and location of court which entered the judgment of conviction you are challenging: 

2. Case Number: 

3. Date of judgment of conviction: (month/day/year)

4. Length and terms of sentence(s): 

5. Nature of offense(s) of which you were convicted (all counts): 

6. What was your plea? G Guilty G Not guilty G Nolo contendere

7. Kind of trial: G Jury G Judge only

8. Did you testify at the trial? G Yes G No

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B. APPEALS

1. Did you appeal the conviction or sentence? G Yes G No

If you did appeal, answer the following:

a. Name of court: 

b. Date the appeal was filed: (month/day/year)

c. Result: 

d. Date the appeal was decided: (month/day/year)

e. Date the mandate was issued: (month/day/year)

2. Did you seek review of your appeal in the state supreme court? G Yes G No

If you did file a petition for review, answer the following:

a. Date the petition was filed: (month/day/year)

b. Result: 

c. Date the petition was decided: (month/day/year)

d. Date the mandate was issued: (month/day/year)

C. FIRST STATE POST-CONVICTION PROCEEDINGS

1. Did you file a petition for post-conviction relief in the state court? G Yes G No

If you did file a petition for post-conviction relief, answer the following:

a. Name of court: 

b. Date the notice of post-conviction relief was filed: (month/day/year)

c. Date the petition was filed: (month/day/year)

d. Result: 

e. Date the petition was decided: (month/day/year)

2. Did you seek review of your first petition in the court of appeals? G Yes G No

If you did file a petition for review, answer the following:

a. Date the petition was filed: (month/day/year)

b. Result: 

c. Date the petition was decided: (month/day/year)

d. Date the mandate was issued: (month/day/year)

3. Did you seek review of your first petition in the state supreme court? G Yes G No

If you did file a petition for review, answer the following:

a. Date the petition was filed: (month/day/year)

b. Result: 

c. Date the petition was decided: (month/day/year)

d. Date the mandate was issued: (month/day/year)

D. SECOND STATE POST-CONVICTION PROCEEDINGS

1. Did you file a second petition for post-conviction relief in the state court? G Yes G No

If you did file a second petition for post-conviction relief, answer the following:

a. Name of court: 

b. Date the notice of post-conviction relief was filed: (month/day/year)

c. Date the petition was filed: (month/day/year)

d. Result: 

e. Date the petition was decided: (month/day/year)

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2. Did you seek review of your second petition in the court of appeals? G Yes G No

If you did file a petition for review, answer the following:

a. Date the petition was filed: (month/day/year)

b. Result: 

c. Date the petition was decided: (month/day/year)

d. Date the mandate was issued: (month/day/year)

3. Did you seek review of your second petition in the state supreme court? G Yes G No

If you did file a petition for review, answer the following:

a. Date the petition was filed: (month/day/year)

b. Result: 

c. Date the petition was decided: (month/day/year)

d. Date the mandate was issued: (month/day/year)

E. OTHER STATE PROCEEDINGS

1. Did you seek review of your conviction in any other state proceeding? G Yes G No

If you did challenge your conviction in some other action, answer the following:

a. Nature of the action: (e.g., special action, habeas corpus, etc.)

b. Name of court: 

c. Date the action was filed: (month/day/year)

d. Result: 

e. Date the action was decided: (month/day/year)

2. Did you seek review of the other action in the court of appeals? G Yes G No

If you did file a petition for review, answer the following:

a. Result: 

b. Date the petition was decided: (month/day/year)

3. Did you seek review of the other action in the state supreme court? G Yes G No

If you did file a petition for review, answer the following:

a. Result: 

b. Date the petition was decided: (month/day/year)

Attach a copy of all state court written decisions regarding your conviction or sentence

F. FEDERAL PROCEEDINGS

Is this your first federal petition for writ of habeas corpus challenging this conviction? G Yes G No

If this is not your first federal petition challenging this conviction, answer the following:

1. Name of court where the prior petition was filed: 

2. Date the petition was filed: (month/day/year)

3. Case number of the prior action: 

4. Date the action was decided: (month/day/year)

5. Did you raise any of the issues in this petition in your prior petition? G Yes G No

6. Was the prior petition G Granted, G Denied on the merits, or G Denied on procedural grounds?

7. If the prior petition was denied, has the Ninth Circuit Court of Appeals granted permission to file this

successive petition? G Yes G No

Attach a copy of all Ninth Circuit Court of Appeals written decisions

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G. PENDING PROCEEDINGS

Do you have any appeal, petition, application, motion or other action currently pending regarding the

conviction you are challenging in this petition? G Yes G No

If you do have an action currently pending regarding your conviction, answer the following:

1. Nature of the action: (e.g., appeal, special action, habeas corpus, etc.)

2. Name of court where the action is pending: 

3. Date the action was filed: (month/day/year)

H. REPRESENTATION

Who was the attorney who represented you in the following state court proceedings? Identify whether

the attorney was appointed, retained, or whether you represented yourself pro se (without counsel).

Name of Attorney Appointed Retained Pro Se

1. Preliminary hearing: G G G

2. Arraignment and plea: G G G

3. Trial/guilty plea: G G G

4. Sentencing: G G G

5. Direct appeal: G G G

6. First post-conviction petition: G G G

7. Second post-conviction petition: G G G

I. OTHER SENTENCES

Do you have any other sentences to serve after you complete the sentence imposed by the judgment you

are challenging in this petition? G Yes G No

If you do have other sentences to serve, answer the following:

1. Name of the court that imposed the other sentence: 

2. Date of judgment of conviction: (month/day/year)

3. Length and terms of sentence: 

4. Have you filed or do you plan to file any petition attacking the judgment which imposed the sentence to

be served in the future? G Yes G No

CLAIMS FOR RELIEF

On the following pages, state concisely every ground for which you claim that your conviction or sentence

violates the United States Constitution or other federal law. Your claims should not be based on state law.

Summarize briefly the facts supporting each ground. If necessary, you may attach pages stating additional

grounds and supporting facts. You must raise all grounds for relief that relate to this conviction. Any

grounds not raised in this petition will likely be barred from being raised in any subsequent federal action.

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J. GROUND I

1. My state conviction or sentence violates the following constitutional right or other federal law: 

2. Supporting Facts: (State as briefly as possible the FACTS supporting Ground I. State the facts clearly

in your own words without citing cases or legal arguments).

3. Exhaustion of state court remedies:

a. Did you present the issue raised in Ground I to the state supreme court? G Yes G No

b. If you did present the issue to the state supreme court, was the issue presented:

G In a direct appeal

G In your first post-conviction relief proceeding

G In your second post-conviction relief proceeding

G Other: (e.g., special action, habeas corpus, etc.)

c. If you did not present the issue to the state supreme court, explain why you did not:

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K. GROUND II

1. My state conviction or sentence violates the following constitutional right or other federal law: 

2. Supporting Facts: (State as briefly as possible the FACTS supporting Ground II. State the facts clearly

in your own words without citing cases or legal arguments).

3. Exhaustion of state court remedies:

a. Did you present the issue raised in Ground II to the state supreme court? G Yes G No

b. If you did present the issue to the state supreme court, was the issue presented:

G In a direct appeal

G In your first post-conviction relief proceeding

G In your second post-conviction relief proceeding

G Other: (e.g., special action, habeas corpus, etc.)

c. If you did not present the issue to the state supreme court, explain why you did not:

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L. GROUND III

1. My state conviction or sentence violates the following constitutional right or other federal law: 

2. Supporting Facts: (State as briefly as possible the FACTS supporting Ground III. State the facts clearly

in your own words without citing cases or legal arguments).

3. Exhaustion of state court remedies:

a. Did you present the issue raised in Ground III to the state supreme court? G Yes G No

b. If you did present the issue to the state supreme court, was the issue presented:

G In a direct appeal

G In your first post-conviction relief proceeding

G In your second post-conviction relief proceeding

G Other: (e.g., special action, habeas corpus, etc.)

c. If you did not present the issue to the state supreme court, explain why you did not:

Case 2:06-cv-02926-SMM--DKD Document 3 Filed 12/28/06 Page 16 of 20
8

M. GROUND IV

1. My state conviction or sentence violates the following constitutional right or other federal law: 

2. Supporting Facts: (State as briefly as possible the FACTS supporting Ground IV. State the facts clearly

in your own words without citing cases or legal arguments).

3. Exhaustion of state court remedies:

a. Did you present the issue raised in Ground IV to the state supreme court? G Yes G No

b. If you did present the issue to the state supreme court, was the issue presented:

G In a direct appeal

G In your first post-conviction relief proceeding

G In your second post-conviction relief proceeding

G Other: (e.g., special action, habeas corpus, etc.)

c. If you did not present the issue to the state supreme court, explain why you did not:

Case 2:06-cv-02926-SMM--DKD Document 3 Filed 12/28/06 Page 17 of 20
9

WHEREFORE, Petitioner prays that the court will grant Petitioner the relief to which he may be entitled

in this proceeding.

I declare under penalty of perjury that the foregoing is true and correct.

Executed on 

DATE SIGNATURE OF PETITIONER

(Name and title of paralegal, legal assistant or

other person who helped prepare this petition)

(Signature of attorney, if any)

(Attorney’s address & telephone number)

ADDITIONAL PAGES

All questions must be answered concisely in the proper space on the form. If needed, you may attach

additional pages. The form, however, must be completely filled in to the extent applicable.

Case 2:06-cv-02926-SMM--DKD Document 3 Filed 12/28/06 Page 18 of 20
98-ifphab

Revised 6/98 1

Name and Prisoner/Booking Number

Place of Confinement

Mailing Address

City, State, Zip Code

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

)

 , )

Petitioner, ) CASE NO. 

)

 vs. )

) APPLICATION TO PROCEED

 , ) IN FORMA PAUPERIS

Respondent(s). ) BY A PRISONER

) (HABEAS)

I, , declare, in support of my request to proceed in the above

entitled case without prepayment of fees under 28 U.S.C. § 1915, that I am unable to pay the fees for these

proceedings or to give security therefor and that I believe I am entitled to relief.

In support of this application, I answer the following questions under penalty of perjury:

1. Are you currently employed at the institution where you are confined? GYes GNo

If "Yes," state the amount of your pay and where you work. 

2. Do you receive any other payments from the institution where you are confined? GYes GNo

If "Yes," state the source and amount of the payments. 

Case 2:06-cv-02926-SMM--DKD Document 3 Filed 12/28/06 Page 19 of 20
2

3. Do you have any other sources of income, savings, or assets either inside or outside of the institution where

you are confined? GYes GNo

If "Yes," state the sources and amounts of the income, savings, or assets. 

I declare under penalty of perjury that the above information is true and correct.

DATE SIGNATURE OF APPLICANT

CERTIFICATE OF CORRECTIONAL OFFICIAL

AS TO STATUS OF APPLICANT’S TRUST ACCOUNT

I, , certify that as of the date applicant signed this application:

(Printed name of official)

The applicant’s trust account balance at this institution is: $ .

DATE AUTHORIZED SIGNATURE TITLE/ID NUMBER INSTITUTION 

Case 2:06-cv-02926-SMM--DKD Document 3 Filed 12/28/06 Page 20 of 20