PETITION FOR POST-CONVICTION RELIEF (Rule 40, HRPP) Name: ___________________________________________________________________________________ Prison Number ___________________________________________________________________________ Place of Confinement ______________________________________________________________________ S.P.P. No. _____________________________________________ (to be supplied by the Clerk of the Court) ) ) ) ) (Full name of petitioner) ) PETITIONER, ) VS ) ) ) ) STATE OF HAWAI`I ) RESPONDENT. ) ___________________________________________ )
PETITION TO VACATE, SET ASIDE, OR CORRECT JUDGMENT OR TO RELEASE PETITIONER FOR CUSTODY (1) This petition must be legible handprinted or typewritten, and signed by the petitioner under penalty of perjury. Any false statement of a material fact may serve as the basis for prosecution and conviction of perjury. All questions must be answered concisely in the proper space on the form. Additional pages are not permitted except with the respect to the facts which you rely upon to support your grounds for relief. If briefs or arguments or citation of authorities are submitted, they should be submitted in the form of a separate memorandum. Upon receipt, your petition will be filed if it is in proper order. No fee is required with this petition. If you do not have the necessary funds for transcripts, counsel, appeal, and other costs connected with a petition of this type, you may request permission to proceed in forma pauperis in which event you must execute the declaration establishing your inability to pay the costs. If you with to proceed in forma pauperis, you must have an authorized officer at the penal institution complete the certificate as to the amount of money and securities on deposit to your credit in any account in the institution. Only judgments entered by one court and judge may be challenged in a single petition. If you seek to challenge judgment entered by different judges or divisions either in the same court or in different court, you must file separate petitions as to each such judgment.
In accordance with the Americans with Disabilities Act and other applicable state and federal laws, if you require a reasonable accommodation for a disability, please contact the ADA Coordinator at the Circuit Court Administration Office at PHONE NO. 961-7440, FAX 961-7416, or TTY 961-7525 at least ten (10) working days prior to your hearing or appointment date.
Reprographics (03/07)
(2)
(3) (4)
(5)
PETITION FOR POST-CONVICTION RELIEF (Rule 40, HRPP)
3C-P-375
(6)
(7)
(8)
Your attention is directed to the fact that you must include all grounds for relief and all facts supporting such grounds for relief in the petition you file seeking relief from any judgment of conviction. When the petition is fully completed, the original and two copies must be mailed to the Clerk of the Court in which the conviction was entered, whose address is: (to be stamped in by the Clerk) ______________________________________________________________________________ Petitions which do not conform to these instructions will be returned with a notation as to the deficiency, and will not be processed or considered until the deficiency is cured. PETITION Name and location of court which entered the judgment of conviction under attack ____________ ______________________________________________________________________________ (a) Case No. _______________________________________________________________ Date of judgment of conviction _____________________________________________________ Length of sentence _______________________________________________________________ Nature of offense involved (all counts) _______________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ What was plea? (Check one) (a) Not guilty (b) Guilty (c) Nolo contendere If entered a guilty plea to one court or indictment, and a not guilty plea to another count or indictment, give details: ____________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Kind of trial (Check one) (a) Jury (b) Judge only Did you testify at the trial? Yes No Did you appeal from the judgment of convictions? Yes No
1.
2. 3. 4.
5.
6.
7. 8.
Reprographics (03/07)
PETITION FOR POST-CONVICTION RELIEF (Rule 40, HRPP)
3C-P-375
9.
If you did appeal, answer the following: (a) Supreme Court No. _______________________________________________________ (b) Result _________________________________________________________________ (c) Date of result ____________________________________________________________ 10. Other than a direct appeal from the judgment of conviction and sentence, have you previously filed any petitions, applications or motions with respect to this judgment in any court? Yes No 11. If your answer to 10 is "yes", give the following information: (a) (1) Name of court _____________________________________________________ (2) Case No. _________________________________________________________ (3) Name of judge ____________________________________________________ (4) Nature of proceeding _______________________________________________ ________________________________________________________________ (5) Grounds raised ____________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ (6) Did you receive an evidentiary hearing on your petition, application or motion? Yes No (7) Results __________________________________________________________ (8) Date of result _____________________________________________________ (b) As to any second petition, application or motion, give the same information: (1) Name of court _____________________________________________________ (2) Case No. _________________________________________________________ (3) Name of judge ____________________________________________________ (4) Nature of proceeding _______________________________________________ ________________________________________________________________ (5) Grounds raised ____________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ (6) Did you receive an evidentiary hearing on your petition, application or motion? Yes No (7) Results __________________________________________________________ (8) Date of result _____________________________________________________
Reprographics (03/07)
PETITION FOR POST-CONVICTION RELIEF (Rule 40, HRPP)
3C-P-375
12.
As to any third petition, application or motion, give the same information: (1) Name of court _____________________________________________________ (2) Case No. _________________________________________________________ (3) Name of judge ____________________________________________________ (4) Nature of proceeding _______________________________________________ ________________________________________________________________ (5) Grounds raised ____________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ (6) Did you receive an evidentiary hearing on your petition, application or motion? Yes No (7) Results __________________________________________________________ (8) Date of result _____________________________________________________ (d) Did you appeal, to the Supreme Court of Hawai`i, the result of action taken on any petition, application or motion? (1) First petition, etc. Yes No (Supreme Court No. ___________ ) (2) Second petition, etc. Yes No (Supreme Court No. ___________ ) (3) Third petition, etc. Yes No (Supreme Court No. ___________ ) (e) If you did not appeal from the adverse action on any petition, application or motion, explain briefly why you did not:_______________________________________ ________________________________________________________________ ________________________________________________________________ State concisely every ground on which you claim that 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. CAUTION: If you fail to set forth all grounds in this petition, you may be barred from presenting additional grounds at a later date. For your information, the following is a list of the most frequently raised grounds for relief in these proceedings. Each statement preceded by a letter constitutes a separate ground for possible relief. You may raise any grounds which you have other than those listed. However, you should raise in this petition all available grounds (relating to this conviction) on which you based your allegations that you are being held in custody unlawfully.
(c)
Reprographics (03/07)
PETITION FOR POST-CONVICTION RELIEF (Rule 40, HRPP)
3C-P-375
Do not check any of these listed grounds. If you select one or more of these grounds for relief, you must allege facts. The petition will be returned to you if you merely check (a) through (j) or any one of the grounds. (a) Conviction obtained by plea of guilty which was unlawfully induced or not made voluntarily or with understanding of the nature of the charge and the consequences of the plea. (b) Conviction obtained by use of coerced confession. (c) Conviction obtained by use of evidence gained pursuant to an unconstitutional search and seizure. (d) Conviction obtained by use of evidence obtained pursuant to an unlawful arrest. (e) Conviction obtained by a violation of the privilege against self-incrimination. (f) Conviction obtained by the unconstitutional failure of the prosecution to disclose to the defendant evidence favorable to the defendant. (g) Conviction obtained by a violation of the protection against double jeopardy. (h) Conviction obtained by action of a grand or petit jury which was unconstitutionally selected and impaneled. (i) Denial of effective assistance of counsel. (j) Denial of right of appeal. A. Ground one: __________________________________________________________ ____________________________________________________________________ Supporting FACTS (tell your story briefly without citing cases or laws): __________ ____________________________________________________________________ ____________________________________________________________________ Ground two: __________________________________________________________ ____________________________________________________________________ Supporting FACTS (tell your story briefly without citing cases or laws): __________ ____________________________________________________________________ ____________________________________________________________________ Ground three: _________________________________________________________ ____________________________________________________________________ Supporting FACTS (tell your story briefly without citing cases or laws): __________ ____________________________________________________________________ ____________________________________________________________________ Ground four: __________________________________________________________ ____________________________________________________________________ Supporting FACTS (tell your story briefly without citing cases or laws): __________ ____________________________________________________________________ ____________________________________________________________________
PETITION FOR POST-CONVICTION RELIEF (Rule 40, HRPP) 3C-P-375
B.
C.
D.
Reprographics (03/07)
13. If any of the grounds listed in 12A, B, C, and D were not previously presented, state briefly what grounds were not so presented, and give your reasons for not presenting them: _______________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 14. Do you have any petition or appeal now pending in any court as to the judgment under attack? Yes If so, give court name(s) and case number(s) _______________________________________________________________ _______________________________________________________________ No 15. Give the name and address, if known, of each attorney who represented you in the following stages of the judgments attached herein: (a) At preliminary hearing ____________________________________________________ _________________________________________________________________________ (b) At arraignment and plea ___________________________________________________ _________________________________________________________________________ (c) At trial _________________________________________________________________ _________________________________________________________________________ (d) At sentencing ____________________________________________________________ _________________________________________________________________________ (e) On appeal ______________________________________________________________ _________________________________________________________________________ (f) In any post-conviction proceedings ___________________________________________ _________________________________________________________________________ (g) On appeal from any adverse ruling in a post-conviction proceeding _________________ _________________________________________________________________________ 16. Were you sentenced on more than one court of a charge or an indictment, or on more than one charge or indictment, in the same court and at approximately the same time? Yes No
Reprographics (03/07)
PETITION FOR POST-CONVICTION RELIEF (Rule 40, HRPP)
3C-P-375
17. Do you have any future sentence to serve after you complete the sentence imposed by the judgment under attack? Yes No (a) If so, give the case number and the name and location of court which imposed sentence to be served in the future: _________________________________________________________ _________________________________________________________________________ (b) And give date and length of sentence to be served in the future: ____________________ _________________________________________________________________________ (c) Have you filed, or do you contemplate filing any petition attaching the judgment which imposed the sentence to be served in the future? Yes No Wherefore, petitioner prays that the Court grant him all relief to which he may be entitled in this proceeding.
________________________________________
Signature of Attorney (if any)
I declare (or certify, verify, or state) under penalty of perjury that the foregoing is true and correct. Executed on ___________________________________ . (date)
________________________________________
Signature of Petitioner
Reprographics (03/07)
PETITION FOR POST-CONVICTION RELIEF (Rule 40, HRPP)
3C-P-375
CLEAR