A petition that challenges the validity of a judgment of conviction or sentence 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 (VALIDITY OF JUDGMENT OF CONVICTION OR SENTENCE) .......................................................... Respondent. INSTRUCTIONS: (1) Use this form if you are currently serving a sentence pursuant to a judgment of conviction and are seeking relief from your judgment of conviction or sentence. Do not use this form if you are challenging the postconviction computation of your time served. (2) This petition must be legibly handwritten or typewritten, signed by the petitioner and verified. (3) Additional pages are not permitted except where noted or with respect to the facts that support your grounds for relief. You are not required to cite to law or authorities. If you submit briefs or arguments, they must be in a separate memorandum. (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 within its custody, name the Director of the Department of Corrections. (6) You must include all grounds for relief which you may have regarding your judgment of conviction or sentence. Failure to raise all grounds in this petition may preclude you from filing future petitions challenging your judgment of conviction and sentence. (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. If your petition contains a claim of ineffective assistance of counsel, that claim will operate to waive the attorney-client privilege for the proceeding in which you claim your counsel was ineffective. (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 were convicted. One copy must be mailed or electronically delivered to the respondent, one copy to the Attorney Generals Office, and one copy to the prosecuting agency. 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 which entered the judgment of conviction being challenged: .......................................................................................................................................... 3. Date of judgment of conviction: .................................................................. 4. Case number: .................................................................................................. 5. (a) Length of sentence: ................................................................................ .......................................................................................................................................... (b) If sentence is death, state any date upon which execution is scheduled: 6. Are you presently serving a sentence for a judgment of conviction other than the judgment of conviction you are challenging in this petition? Yes ........ No ........ If yes, list each crime, case number and sentence being served at this time: . .......................................................................................................................................... .......................................................................................................................................... 7. Nature of offense involved in the judgment of conviction being challenged: .......................................................................................................................................... 8. What was your plea? (check one) (a) Not guilty ........ (b) Guilty ........ (c) Guilty but mentally ill ........ (d) Nolo contendere ........ 9. If you entered a plea of guilty or guilty but mentally ill to one count of an indictment or information, and a plea of not guilty to another count of an indictment or information, or if a plea of guilty or guilty but mentally ill was negotiated, give details: ............................................................................................................................ .......................................................................................................................................... .......................................................................................................................................... 10. If you were found guilty or guilty but mentally ill after a plea of not guilty, was the finding made by: (check one) (a) Jury ........ (b) Judge without a jury ........ 11. Did you testify at the trial? Yes ........ No ........ 12. Did you appeal from the judgment of conviction? Yes ........ No ........ 13. If you did appeal, answer the following: (a) Name of court: ................................................................................................ (b) Case number or citation: ............................................................................... (c) Result: ............................................................................................................... (d) Date of result: .................................................................................................. (Attach copy of order or decision, if available.) 14. If you did not appeal, explain briefly why you did not: ........................ .......................................................................................................................................... .......................................................................................................................................... 15. Other than a direct appeal from the judgment of conviction, have you previously filed any petitions, applications or motions with respect to this judgment in any court, state or federal? Yes ........ No ........ 16. If your answer to No. 15 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 petition, application or motion, give the same information: (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: .......................................................................................................................................... (c) As to any third or subsequent additional applications or motions, give the same information as above, list them on a separate sheet and attach. (d) 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 petition, application or motion? Yes ........ No ......... Citation or date of decision: .................................................................... (3) Third or subsequent petitions, applications or motions? Yes ........ No ........ Citation or date of decision: .................................................................... (e) 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.) .......................................................................................................................................... .......................................................................................................................................... 17. Has any ground being raised in this petition been previously presented to this or any other court by way of petition for habeas corpus, motion, application or any other postconviction proceeding? If so, identify: (a) Which of the grounds is the same: ............................................................... .......................................................................................................................................... (b) The proceedings in which these grounds were raised: ............................. .......................................................................................................................................... (c) Briefly 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.) ................................................... .......................................................................................................................................... 18. If any of the grounds listed in Nos. 23(a), (b), (c) and (d), or listed on any additional pages you have attached, were not previously presented in any other court, state or federal, list briefly what grounds were not so presented, and give your reasons for not presenting them. (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. Are you filing this petition more than 1 year following the filing of the judgment of conviction or the filing of a decision on direct appeal? If so, state briefly the reasons for the delay. (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.) ...................................... .......................................................................................................................................... 20. Do you have any petition or appeal now pending in any court, either state or federal, as to the judgment of conviction you are challenging in this petition? Yes ........ No ........ If yes, state what court and the case number: .......................................................... .......................................................................................................................................... 21. Give the name of each attorney who represented you in the proceeding resulting in your judgment of conviction and on direct appeal: ............................................................................................................ .......................................................................................................................................... 22. Do you have any future sentences to serve after you complete the sentence imposed by the judgment of conviction you are challenging in this petition? Yes ........ No ........ If yes, specify where and when it is to be served, if you know: ........................... .......................................................................................................................................... 23. State concisely every ground on which you claim that you are being held unlawfully. 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 OF SERVICE 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 (VALIDITY OF JUDGMENT OF CONVICTION OR SENTENCE) addressed to: ............................................................................................................... Respondent prison or jail official ............................................................................................................... Address ............................................................................................................... Attorney General 100 North Carson Street Carson City, Nevada 89701 ............................................................................................................... District Attorney of County of Conviction ............................................................................................................... Address ............................................................... 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 (VALIDITY OF JUDGMENT OF CONVICTION OR SENTENCE) 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 ............................................................................................................... District Attorney of County of Conviction ............................................................................................................... Address ............................................................... Signature of Petitioner
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