A petition for a writ of habeas corpus that challenges the computation of time that the petitioner has served pursuant to a judgment of conviction must be in substantially the following form, with appropriate modifications if the petition is filed in the Court of Appeals or the Supreme Court: Case No. .................................. Dept. No. .................................. IN THE .................. JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA IN AND FOR THE COUNTY OF.................. ............................................................................ Petitioner, v. PETITION FOR WRIT OF HABEAS CORPUS (COMPUTATION OF TIME) ............................................................................ Respondent. INSTRUCTIONS: (1) Use this form if you are currently serving a sentence pursuant to a judgment of conviction and are challenging the postconviction computation of your time served, the revocation of your parole or the forfeiture of your credits. Do not use this form if you are requesting relief from a judgment of conviction. (2) This petition must be legibly handwritten or typewritten, signed by the petitioner and verified. (3) You must include facts which support your grounds for relief. You do not need to cite law or authorities. You may submit additional pages if necessary with this form. (4) If you want an attorney appointed, you must complete an Affidavit in Support of Request to Proceed in Forma Pauperis. An authorized officer at the prison must complete the certificate as to the amount of money and securities on deposit to your credit in any account in the institution. (5) You must name as respondent the person by whom you are confined or restrained. If you are in a specific institution of the Department of Corrections, name the warden or head of the institution. If you are not in a specific institution of the Department but: (a) Within its custody, name the Director of the Department of Corrections. (b) Under the supervision of the Division of Parole and Probation of the Department of Public Safety, name the probation officer or parole officer assigned to you at this time. (6) You must include all grounds for relief which you may have regarding the computation of time served on your sentence. Failure to raise all grounds in this petition may preclude you from filing future petitions challenging the same computation of time issue. (7) You must allege specific facts supporting the claims in this petition. Failure to allege specific facts rather than just conclusions may cause your petition to be dismissed. (8) When the petition is fully completed, the original and one copy must be filed with the clerk of the state district court for the county in which you are incarcerated, or, if you are incarcerated outside this State, the First Judicial District Court in and for Carson City. One copy must be mailed or electronically delivered to the respondent and one copy must be mailed or electronically delivered to the Attorney Generals Office. Copies must conform in all particulars to the original submitted for filing. PETITION 1. Name of institution and county in which you are presently imprisoned or where and how you are presently restrained of your liberty: .............................................................................................................. .......................................................................................................................................... 2. Name and location of court that sentenced you: ....................................... .......................................................................................................................................... 3. Case number: .................................................................................................. 4. Date of judgment of conviction: .................................................................. 5. (a) Nature of the underlying offense involved in the sentence being challenged in this petition: (b) Date on which the underlying offense involved in the sentence being challenged in this petition was committed: 6. Length of sentence being challenged in this petition:............................... .......................................................................................................................................... 7. Are you presently serving a sentence other than the sentence being challenged in this petition? Yes ........ No ........ If yes, list each crime, case number and sentence being served at this time: .......................................................................................................................................... .......................................................................................................................................... .......................................................................................................................................... 8. Have your sentences been aggregated? Yes ........ No ........ If yes, list each case number and sentence, the terms of which have been aggregated: .......................................................................................................................................... .......................................................................................................................................... 9. Do you have any future sentences to serve after you complete the sentence being challenged in this petition (whether in the same judgment or a different judgment)? Yes ........ No ........ If yes, specify where and when it is to be served, if you know: ....................... 10. Have you had a parole hearing relating to the sentence you are challenging in this petition? Yes ........ No ........ If yes, give the following information: (a) Date of most recent parole hearing: ............................................................ (b) Outcome of most recent parole hearing: .................................................... (c) Date on which the rehearing is to be held, if you know: ......................... 11. Are you challenging a decision of the State Board of Parole Commissioners to revoke your parole? Yes ........ No ........ If yes, give the following information: (a) Date of revocation hearing: ........................................................................... (b) Date on which your next parole hearing is scheduled, if you know: .... (c) Did you forfeit any credit as a result of the revocation of parole? Yes ........ No ........ (d) If you forfeited any credit as a result of the revocation of parole, has any of the credit forfeited been restored? Yes ........ No ........ 12. Are you challenging a disciplinary sanction? Yes ........ No ........ If yes, give the following information: (a) Date on which you were served with a notice of the disciplinary offense charged: (b) Date on which the disciplinary hearing involving the charged offense was conducted: (c) Did you forfeit any credit as a result of the disciplinary hearing? Yes ........ No ........ (d) If you forfeited any credit as a result of the disciplinary hearing, has any of the credit forfeited been restored? Yes ........ No ........ 13. Have you previously filed any petitions, applications or motions with respect to the challenge raised in this petition in any court, state or federal? Yes ........ No ........ 14. If your answer to No. 13 was yes, give the following information: (a) (1) Name of court: .......................................................................................... (2) Nature of proceeding: .............................................................................. .......................................................................................................................................... (3) Grounds raised: ........................................................................................ .......................................................................................................................................... .......................................................................................................................................... (4) Did you receive an evidentiary hearing on your petition, application or motion? Yes ........ No ........ (5) Result: ........................................................................................................ (6) Date of result: ........................................................................................... (7) If known, citations of any written opinion or date of orders entered pursuant to such result: (b) As to any second or subsequent additional petitions, applications or motions, give the same information as above, list them on a separate sheet and attach. (c) Did you appeal to the highest state or federal court having jurisdiction, the result or action taken on any petition, application or motion? (1) First petition, application or motion? Yes ........ No ........ Citation or date of decision: .................................................................... (2) Second or subsequent petitions, applications or motions? Yes ........ No ........ Citation or date of decision: .................................................................... (d) If you did not appeal from the adverse action on any petition, application or motion, explain briefly why you did not. (You must relate specific facts in response to this question. Your response may be included on paper which is 8 1/2 by 11 inches attached to the petition. Your response may not exceed five handwritten or typewritten pages in length.) .......................................................................................................................................... 15. Do you have any petition or appeal now pending in any court, state or federal, regarding the computation of time you are challenging in this petition? Yes ........ No ........ If yes, give the following information: (a) Name of court: ................................................................................................ (b) Case number: ................................................................................................... 16. Have you filed a grievance raising the same computation of time issue as you are raising in this petition? Yes ........ No ........ 17. If your answer to No. 16 was yes, answer the following: (a) Number assigned to your grievance: ........................................................... (b) Result of grievance: ....................................................................................... (c) Did you complete all levels of the grievance procedure? Yes ........ No ........ (d) If you did not complete all levels of the grievance procedure, explain briefly why you did not: .......................................................................................................................................... 18. If any of the grounds being raised in this petition have been submitted for review and resolution by way of the grievance process, explain why you are again raising these grounds. (You must relate specific facts in response to this question. Your response may be included on paper which is 8 1/2 by 11 inches attached to the petition. Your response may not exceed five handwritten or typewritten pages in length.) ................................................... .......................................................................................................................................... .......................................................................................................................................... 19. State concisely every ground on which you claim that the computation of time you have served has been improperly computed. Summarize briefly the facts supporting each ground. If necessary you may attach pages stating additional grounds and facts supporting the same. (a) Ground one: ..................................................................................................... .......................................................................................................................................... Supporting FACTS (Tell your story briefly without citing cases or law.): ........ .......................................................................................................................................... .......................................................................................................................................... (b) Ground two: ..................................................................................................... .......................................................................................................................................... Supporting FACTS (Tell your story briefly without citing cases or law.): ........ .......................................................................................................................................... .......................................................................................................................................... (c) Ground three: ................................................................................................... .......................................................................................................................................... Supporting FACTS (Tell your story briefly without citing cases or law.): ........ .......................................................................................................................................... .......................................................................................................................................... (d) Ground four: .................................................................................. .......................................................................................................................................... Supporting FACTS (Tell your story briefly without citing cases or law.): ........ .......................................................................................................................................... .......................................................................................................................................... WHEREFORE, petitioner prays that the court grant petitioner relief to which petitioner may be entitled in this proceeding. EXECUTED at ................... on the ....... day of the month of ....... of the year ....... ............................................................... Signature of petitioner ............................................................... Address .................................................................. Signature of attorney (if any) .................................................................. Attorney for petitioner .................................................................. Address VERIFICATION Under penalty of perjury, the undersigned declares that the undersigned is the petitioner named in the foregoing petition and knows the contents thereof; that the pleading is true of the undersigneds own knowledge, except as to those matters stated on information and belief, and as to such matters the undersigned believes them to be true. ............................................................... Petitioner ............................................................... Attorney for petitioner CERTIFICATE OF SERVICE (PLEASE SIGN THE APPROPRIATE METHOD YOU WISH TO USE) CERTIFICATE OF SERVICE BY MAIL I, ................................, hereby certify, pursuant to N.R.C.P. 5 (b), that on this ........ day of the month of ........ of the year ........, I mailed a true and correct copy of the foregoing PETITION FOR WRIT OF HABEAS CORPUS (COMPUTATION OF TIME) addressed to: ............................................................................................................... Respondent prison or jail official ............................................................................................................... Address ............................................................................................................... Attorney General 100 North Carson Street Carson City, Nevada 89701 ............................................................... Signature of Petitioner CERTIFICATE OF SERVICE BY ELECTRONIC MEANS I, ................................, hereby certify that on this ........ day of the month of ........ of the year ........, I electronically delivered a true and correct copy of the foregoing PETITION FOR WRIT OF HABEAS CORPUS (COMPUTATION OF TIME) addressed to: ............................................................................................................... Respondent prison or jail official ............................................................................................................... Electronic mail address or other electronic means for service ............................................................................................................... Attorney General 100 North Carson Street Carson City, Nevada 89701 ............................................................... Signature of Petitioner
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