UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF ALABAMA
INSTRUCTIONS FOR FILING A PETITION
FOR WRIT OF HABEAS CORPUS UNDER 28 U.S.C. § 2254
1. To use this form, you must be a person currently serving a sentence under a judgment against you in state
court. If you wish to challenge the validity of a federal judgment of conviction and sentence, you should
not use this form and instead file a motion under 28 U.S.C. § 2255 in the federal court which entered the
judgment.
2. You may also use this form to challenge a state court judgment that imposed a sentence to be served in
the future, but you must fill in the name of the state where the judgment was entered.
3. This petition must be legibly handwritten or typewritten and signed by the petitioner under penalty of
perjury. If you make a false statement of a material fact, you may be prosecuted for perjury.
4. All questions must be answered concisely in the proper space on the form. If needed, you may attach
additional pages. If you attach additional pages, number the pages and identify which section of the
petition is being continued. Do NOT write on the back of any page.
5. Do not use this form unless you were convicted in a state court in one of the following Alabama counties:
BIBB, BLOUNT, CALHOUN, CHEROKEE, CLAY, CLEBURNE, COLBERT, CULLMAN, DEKALB,
ETOWAH, FAYETTE, FRANKLIN, GREENE, JACKSON, JEFFERSON, LAMAR, LAUDERDALE,
LAWRENCE, LIMESTONE, MADISON, MARION, MARSHALL, MORGAN, PICKENS, SHELBY,
ST. CLAIR, SUMTER, TALLADEGA, TUSCALOOSA, WALKER, or WINSTON.
6. In order for your petition to be filed, it must be accompanied by the $5.00 filing fee. If you are unable to
pay the filing fee, you may petition the court to proceed as an indigent party. An Application to Proceed
In Forma Pauperis is included with this petition.
7. No more than one petitioner may be named in a petition. Each petitioner must file a separate petition and
pay the filing fee or submit an Application to Proceed In Forma Pauperis.
8. Only judgments entered by one court may be challenged in a single petition. If you seek to challenge
judgments entered by different courts, you must file separate petitions as to each court.
9. You must include in this petition all grounds for relief from the conviction or sentence that you challenge,
and you must state the facts that support each ground. If you fail to set forth all the grounds in this
petition, you may be barred from presenting additional grounds at a later date.
10. Capital Cases: If you are under a sentence of death and are indigent, you may be entitled to the assistance
of counsel and should request the appointment of counsel.
11. You must immediately notify the court in writing of any change of address. If you do not, the court may
dismiss your case.
12. Mail the original petition and the filing fee of $5.00 or an Application to Proceed In Forma Pauperis to
the following address: Clerk’s Office, United States District Court, Northern District of Alabama, Room
140, Hugo L. Black U.S. Courthouse, 1729 5th Avenue North, Birmingham, AL 35203-2195 or Clerk’s
Office, United States District Court, Northern District of Alabama, 101 Holmes Avenue, Huntsville, AL
35801.
AO 241 (Rev. 10/16)
UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF ALABAMA
PETITION UNDER 28 U.S.C. § 2254 FOR WRIT OF
HABEAS CORPUS BY A PERSON IN STATE CUSTODY
)
___________________________________________________ )
Plaintiff-Petitioner )
(Full name under which you were convicted) )
)
Place of ) Civil Action No. __________________
Confinement: ________________________________________ ) (to be filled in by the
) Clerk’s Office)
Prisoner No.: ________________________________________ )
)
-v- )
)
____________________________________________________ )
Respondent )
(Name of Warden, Superintendent, Jailer, or authorized person )
having custody of petitioner.) )
)
and )
)
)
THE ATTORNEY GENERAL OF THE STATE OF ALABAMA )
PETITION
1. (a) Name and location of court that entered the judgment of conviction you are challenging. Do not
use this form unless you were convicted in one of the following counties: BIBB, BLOUNT,
CALHOUN, CHEROKEE, CLAY, CLEBURNE, COLBERT, CULLMAN, DEKALB,
ETOWAH, FAYETTE, FRANKLIN, GREENE, JACKSON, JEFFERSON, LAMAR,
LAUDERDALE, LAWRENCE, LIMESTONE, MADISON, MARION, MARSHALL,
MORGAN, PICKENS, SHELBY, ST. CLAIR, SUMTER, TALLADEGA, TUSCALOOSA,
WALKER, WINSTON.
(b) Criminal docket or case number (if you know):
2. (a) Date of the judgment of conviction (if you know):
(b) Date of Sentencing:
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3. Length of Sentence:
4. In this case, were you convicted on more than one count or more than one crime? ☐ Yes ☐ No
5. Identify all crimes of which you were convicted and sentenced in this case:
6. (a) What was your plea? (Check one)
☐ (1) Not guilty ☐ (3) Nolo contendere (no contest)
☐ (2) Guilty ☐ (4) Insanity plea
(b) If you entered a guilty plea to one count or charge and a not guilty plea to another count or
charge, what did you plead guilty to and what did you plead not guilty to?
(c) If you went to trial, what kind of trial did you have? (Check one)
☐ Jury ☐ Judge only
7. Did you testify at a pretrial hearing, trial, or a post-trial hearing?
☐ Yes ☐ No
8. Did you appeal from the judgment of conviction?
☐ Yes ☐ No
9. If you did appeal, answer the following:
(a) Name of court:
(b) Docket or case number (if you know):
(c) Result:
(d) Date of Result (if you know):
(e) Citation to the case (if you know):
(f) Grounds raised:
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(g) Did you seek further review by a higher state court? ☐ Yes ☐ No
If yes, answer the following:
(1) Name of court:
(2) Docket or case number (if you know):
(3) Result:
(4) Date of result (if you know):
(5) Citation to the case (if you know):
(6) Grounds raised:
(h) Did you file a petition for certiorari in the United States Supreme Court? ☐ Yes ☐ No
If yes, answer the following:
(1) Docket or case number (if you know):
(2) Result:
(3) Date of result (if you know):
(4) Citation to the case (if you know):
10. Other than the direct appeals listed above, have you previously filed any other petitions, applications, or
motions concerning this judgment of conviction in any state court? ☐ Yes ☐ No
11. If your answer to Question 10 was “Yes,” give the following information:
(a) (1) Name of court:
(2) Docket or case number (if you know):
(3) Date of filing (if you know):
(4) Nature of the proceeding:
(5) Grounds raised:
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(6) Did you receive a hearing where evidence was given on your petition, application, or
motion? ☐ Yes ☐ No
(7) Result:
(8) Date of result (if you know):
(b) If you filed any second petition, application, or motion, given the same information:
(1) Name of court:
(2) Docket or case number (if you know):
(3) Date of filing (if you know):
(4) Nature of the proceeding:
(5) Grounds raised:
(6) Did you receive a hearing where evidence was given on your petition, application, or
motion? ☐ Yes ☐ No
(7) Result:
(8) Date of result (if you know):
(c) If you filed any third petition, application, or motion, give the same information:
(1) Name of court:
(2) Docket or case number (if you know):
(3) Date of filing (if you know):
(4) Nature of the proceeding:
(5) Grounds raised:
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(6) Did you receive a hearing where evidence was given on your petition, application, or
motion? ☐ Yes ☐ No
(7) Result:
(8) Date of result (if you know):
(d) Did you appeal to the highest state court having jurisdiction over the action taken on your
petition, application, or motion?
(1) First petition: ☐ Yes ☐ No
(2) Second petition: ☐ Yes ☐ No
(3) Third petition: ☐ Yes ☐ No
(e) If you did not appeal to the highest state court having jurisdiction, explain why you did not:
12. For this petition, state concisely every ground on which you claim that you are being held in violation of
the Constitution, laws, or treaties of the United States. Attach additional pages if you have more than four
grounds. State the facts supporting each ground.
CAUTION: To proceed in the federal court, you must ordinarily first exhaust (use up) your available
state-court remedies on each ground on which you request action by the federal court. Also, if you fail to
set forth all the grounds in this petition, you may be barred from presenting additional grounds at a later
date in a second or successive habeas corpus petition.
GROUND ONE:
(a) Supporting facts (Do not argue or cite law. Just state the specific facts that support your claim):
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(b) If you did not exhaust your state remedies on Ground One, explain why:
(c) Direct Appeal of Ground One:
(1) If you appealed from the judgment of conviction, did you raise this issue: ☐ Yes ☐ No
(2) If you did not raise this issue in your direct appeal, explain why:
(d) Post-Conviction Proceedings:
(1) Did you raise this issue through a post-conviction motion or petition for habeas corpus in
a state trial court: ☐ Yes ☐ No
(2) If your answer to Question (d)(1) is “Yes,” state:
Type of motion or petition:
Name and location of the court where the motion or petition was filed:
Docket or case number (if you know):
Date of the court’s decision:
Result (attach a copy of the court’s opinion or order, if available):
(3) Did you receive a hearing on your motion or petition? ☐ Yes ☐ No
(4) Did you appeal from the denial of your motion or petition? ☐ Yes ☐ No
(5) If your answer to Question (d)(4) is “Yes,” did you raise this issue in the appeal?
☐ Yes ☐ No
(6) If your answer to Question (d)(4) is “Yes,” state:
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Name and location of the court where the motion or petition was filed:
Docket or case number (if you know):
Date of the court’s decision:
Result (attach a copy of the court’s opinion or order, if available):
(7) If your answer to Question (d)(4) or Question (d)(5) is “No,” explain why you did not
raise the issue:
(e) Other Remedies: Describe any other procedures (such as habeas corpus, administrative
remedies, etc.) that you have used to exhaust your state remedies on Ground One:
GROUND TWO:
(a) Supporting facts (Do not argue or cite law. Just state the specific facts that support your claim):
(b) If you did not exhaust your state remedies on Ground Two, explain why:
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(c) Direct Appeal of Ground Two:
(1) If you appealed from the judgment of conviction, did you raise this issue: ☐ Yes ☐ No
(2) If you did not raise this issue in your direct appeal, explain why:
(d) Post-Conviction Proceedings:
(1) Did you raise this issue through a post-conviction motion or petition for habeas corpus in
a state trial court: ☐ Yes ☐ No
(2) If your answer to Question (d)(1) is “Yes,” state:
Type of motion or petition:
Name and location of the court where the motion or petition was filed:
Docket or case number (if you know):
Date of the court’s decision:
Result (attach a copy of the court’s opinion or order, if available):
(3) Did you receive a hearing on your motion or petition? ☐ Yes ☐ No
(4) Did you appeal from the denial of your motion or petition? ☐ Yes ☐ No
(5) If your answer to Question (d)(4) is “Yes,” did you raise this issue in the appeal?
☐ Yes ☐ No
(6) If your answer to Question (d)(4) is “Yes,” state:
Name and location of the court where the motion or petition was filed:
Docket or case number (if you know):
Date of the court’s decision:
Result (attach a copy of the court’s opinion or order, if available):
(7) If your answer to Question (d)(4) or Question (d)(5) is “No,” explain why you did not
raise the issue:
8
(e) Other Remedies: Describe any other procedures (such as habeas corpus, administrative
remedies, etc.) that you have used to exhaust your state remedies on Ground Two:
GROUND THREE:
(a) Supporting facts (Do not argue or cite law. Just state the specific facts that support your claim):
(b) If you did not exhaust your state remedies on Ground Three, explain why:
(c) Direct Appeal of Ground Three:
(1) If you appealed from the judgment of conviction, did you raise this issue: ☐ Yes ☐ No
(2) If you did not raise this issue in your direct appeal, explain why:
(d) Post-Conviction Proceedings:
(1) Did you raise this issue through a post-conviction motion or petition for habeas corpus in
a state trial court: ☐ Yes ☐ No
(2) If your answer to Question (d)(1) is “Yes,” state:
Type of motion or petition:
Name and location of the court where the motion or petition was filed:
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Docket or case number (if you know):
Date of the court’s decision:
Result (attach a copy of the court’s opinion or order, if available):
(3) Did you receive a hearing on your motion or petition? ☐ Yes ☐ No
(4) Did you appeal from the denial of your motion or petition? ☐ Yes ☐ No
(5) If your answer to Question (d)(4) is “Yes,” did you raise this issue in the appeal?
☐ Yes ☐ No
(6) If your answer to Question (d)(4) is “Yes,” state:
Name and location of the court where the motion or petition was filed:
Docket or case number (if you know):
Date of the court’s decision:
Result (attach a copy of the court’s opinion or order, if available):
(7) If your answer to Question (d)(4) or Question (d)(5) is “No,” explain why you did not
raise the issue:
(e) Other Remedies: Describe any other procedures (such as habeas corpus, administrative
remedies, etc.) that you have used to exhaust your state remedies on Ground Three:
GROUND FOUR:
(a) Supporting facts (Do not argue or cite law. Just state the specific facts that support your claim):
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(b) If you did not exhaust your state remedies on Ground Four, explain why:
(c) Direct Appeal of Ground Four:
(1) If you appealed from the judgment of conviction, did you raise this issue: ☐ Yes ☐ No
(2) If you did not raise this issue in your direct appeal, explain why:
(d) Post-Conviction Proceedings:
(1) Did you raise this issue through a post-conviction motion or petition for habeas corpus in
a state trial court: ☐ Yes ☐ No
(2) If your answer to Question (d)(1) is “Yes,” state:
Type of motion or petition:
Name and location of the court where the motion or petition was filed:
Docket or case number (if you know):
Date of the court’s decision:
Result (attach a copy of the court’s opinion or order, if available):
(3) Did you receive a hearing on your motion or petition? ☐ Yes ☐ No
(4) Did you appeal from the denial of your motion or petition? ☐ Yes ☐ No
(5) If your answer to Question (d)(4) is “Yes,” did you raise this issue in the appeal?
☐ Yes ☐ No
(6) If your answer to Question (d)(4) is “Yes,” state:
Name and location of the court where the motion or petition was filed:
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Docket or case number (if you know):
Date of the court’s decision:
Result (attach a copy of the court’s opinion or order, if available):
(7) If your answer to Question (d)(4) or Question (d)(5) is “No,” explain why you did not
raise the issue:
(e) Other Remedies: Describe any other procedures (such as habeas corpus, administrative
remedies, etc.) that you have used to exhaust your state remedies on Ground Four:
13. Please answer these additional questions about the petition you are filing:
(a) Have all grounds for relief that you have raised in this petition been presented to the highest state
court having jurisdiction? ☐ Yes ☐ No
If your answer is “No,” state which grounds have not been so presented and give your reason(s)
for not presenting them:
(b) Is there any ground in this petition that has not been presented in some state or federal court? If
so, which ground or grounds have not been presented, and state your reasons for not presenting
them:
14. Have you previously filed any type of petition, application, or motion in a federal court regarding the
conviction that you challenge in this petition? ☐ Yes ☐ No
If “Yes,” state the name and location of the court, the docket or case number, the type of proceeding, the
issues raised, the date of the court’s decision, and the result for each petition, application, or motion filed.
Attach a copy of any court opinion or order, if available.
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15. Do you have any petition or appeal now pending (filed and not decided yet) in any court, either state or
federal, for the judgment you are challenging? ☐ Yes ☐ No
If “Yes,” state the name and location of the court, the docket or case number, the type of proceeding, and
the issues raised.
16. Give the name and address, if you know, of each attorney who represented you in the following stages of
the judgment you are challenging:
(a) At the preliminary hearing:
(b) At arraignment and plea:
(c) At trial:
(d) At sentencing:
(e) On appeal:
(f) In any post-conviction proceeding:
(g) On appeal from any ruling against you in a post-conviction proceeding:
17. Do you have any future sentence to serve after you complete the sentence for the judgment that you are
challenging? ☐ Yes ☐ No
(a) If so, give name and location of court that imposed the other sentence you will serve in the future:
(b) Give the date the other sentence was imposed:
(c) Give the length of the other sentence:
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(d) Have you filed, or do you plan to file, any petition that challenges the judgment or sentence to be
served in the future? ☐ Yes ☐ No
18. TIMELINESS OF PETITION: If your judgment of conviction became final over one (1) year ago, you
must explain why the one-year statute of limitations as contained in 28 U.S.C. § 2244(d) does not bar
your petition. 1
1
The Antiterrorism and Effective Death Penalty Act of 1996 (“AEDPA”) as contained in 28 U.S.C. § 2244(d)
provides in part that:
(1) A one-year period of limitation shall apply to an application for a writ of habeas corpus by a person in
custody pursuant to the judgment of a state court. The limitation period shall run from the latest of –
(A) the date on which the judgment became final by the conclusion of direct review or the expiration
of the time for seeing such review;
(B) the date on which the impediment to filing an application created by state action in violation of the
Constitution or laws of the United States is removed, if the applicant was prevented from filing by
such state action;
(C) the date on which the constitutional right asserted was initially recognized by the Supreme Court
and made retroactively applicable to cases on collateral review; or
(D) the date on which the factual predicate of the claim or claims presented could have been
discovered through the exercise of due diligence.
(2) The time during which a properly filed application for state post-conviction or other collateral review with
respect to the pertinent judgment or claim is pending shall not be counted toward any period of limitation
under this subsection.
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Therefore, petitioner asks that the court grant the following relief:
or any other relief to which petitioner may be entitled.
Signature of Attorney (if any)
I declare (or certify, verify, or state) under penalty of perjury that the foregoing is true and correct and that this
Petition for Writ of Habeas Corpus was placed in the prison on (month, date, year).
Executed (signed) on
(date)
Signature of Petitioner
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FOR USE BY INCARCERATED PERSONS
IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ALABAMA
APPLICATION TO PROCEED IN FORMA PAUPERIS
Declaring that the personal and financial information I have given below is true and correct, I apply to
this court for authority to proceed with this case without prepayment of fees, costs, or security.
1. Your full name:
Present mailing address:
2. Are you presently employed? ☐ Yes ☐ No
If the answer is “Yes,” give the name and address of your employer and the amount of your usual
monthly salary or wages.
Name and Address:
Amount of earnings: $ per (specify pay period)
If the answer is “No,” give the name and address of your last employer, when you last worked, and the
amount of the monthly salary or wages you were receiving.
Name and Address:
Date last worked:
Amount of earnings: $ per (specify pay period)
3. Have you received within the past twelve months any money from any of the following sources?
(a) Business, profession, or any form of self-employment? Yes G No G
(b) Interest, dividends, rents or investment income of any kind? Yes G No G
(c) Pensions, annuities, or life insurance payments? Yes G No G
(d) Gifts or inheritances? Yes G No G
(e) Any other sources? Yes G No G
If the answer to any of the above is “Yes,” describe each source of money and state the amount received
from each during the past twelve months:
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4. Do you own cash, or do you have any money in any checking or saving accounts, including your prison
or jail account? Yes G No G
If the answer is “yes,” state the total amount: $
5. Do you own any real estate, stocks, bonds, notes, automobiles, boats, or other valuable property
(excluding ordinary household items and clothing)? Yes G No G
If the answer is “Yes,” describe the property and state its approximate value:
6. List the persons who are dependent upon you for support, stating your relationship to them and how much
you contribute toward their support:
I declare (or certify, verify, or state) under penalty of perjury that the foregoing is true and correct.
Dated:
Signature of Petitioner
Address
Prisoner Number
IMPORTANT NOTICE
Your application to proceed in forma pauperis is NOT COMPLETE and WILL NOT BE CONSIDERED
by the court unless the page entitled “INFORMATION REGARDING PRISONER ACCOUNTS” is
properly completed and certified.
INFORMATION REGARDING PRISONER ACCOUNTS
The Prison Litigation Reform Act, Pub. L. No. 104-134, § 804, requires a prisoner seeking to proceed in
forma pauperis to submit information regarding his prison or jail trust account for the six (6) months preceding
the filing of the complaint. This information must be obtained from the appropriate official of each prison or
institution at which the prisoner is or was confined within the past six (6) months. This information must be
certified by prison or jail personnel and must include both the total deposits made to the prisoner’s account each
and every month for the preceding six (6) months and the average monthly balance in the account each and every
month during the preceding six (6) months. Information for six (6) full months must be provided.
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CERTIFICATION
I hereby certify that prisoner has been incarcerated
in this institution since , , and that the prisoner has the sum of
$ in his/her prison or jail trust account on this the day of . I further
certify that the information provided below is true and correct.
Month/Year Total Deposits Received Average Account Balance
Month 1 ______________ $____________________ $______________________
Month 2 ______________ $____________________ $______________________
Month 3 ______________ $____________________ $______________________
Month 4 ______________ $____________________ $______________________
Month 5 ______________ $____________________ $______________________
Month 6 ______________ $____________________ $______________________
Current month ______________ $____________________ $______________________
(if less than full month)
Dated: _______________________ _____________________________________________
Signature of Authorized Officer of Institution
_____________________________________________
Name of Institution
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