Va. R. Sup. Ct. Form 11
PETITION FOR A WRIT OF ACTUAL INNOCENCE
TO THE SUPREME COURT OF VIRGINIA
| In re: _____________________________________________ | Record No. ______________________________________ | |
| (FULL NAME OF PETITIONER) | (TO BE SUPPLIED BY THE CLERK OF THE SUPREME COURT) | |
| ___________________________________________________ | Circuit Court | |
| Case No.(s)_____________________________________ | ||
| (PRISONER NO., IF APPLICABLE) | ||
| ___________________________________________________ | _____________________________________ | |
| (PETITIONER'S ADDRESS) | ||
| ___________________________________________________ | _____________________________________ | |
| ___________________________________________________ | ||
Pursuant to the provisions of Chapter 19.2 of Title 19.2 of the Code of Virginia, I,
____________________________________________________________________ NAME OF PETITIONER
hereby petition this Court for a writ of actual innocence. In support of this petition, I state under oath that the following information is true:
1. On __________________________, was convicted in the DATE
___________________________________Circuit Court of the following offense(s): NAME OF COURT
| Description of Offense | Virginia Code | Plea |
| _______________________________________________________ | __________________ | __________________ |
| _______________________________________________________ | __________________ | __________________ |
| _______________________________________________________ | __________________ | __________________[ ] ATTACHED ADDITIONAL SHEET(S) |
2. I am innocent of the crime(s) for which I was convicted.
3. My claim of innocence is based upon the following human biological evidence and scientific testing:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
[ ] ATTACHED ADDITIONAL SHEET(S)
4. Check one:
[ ] This evidence was not known or available to either me or my attorney at the time the conviction became final in the circuit court.
[ ] This evidence was known at the time the conviction became final in the circuit court, but was not tested because _________________________________________________________________________
[ ] ATTACHED ADDITIONAL SHEET(S)
5. This evidence was tested pursuant to the provisions of Virginia Code § 19.2-327.1 and the results were obtained by me or my attorney on __________________________ .
DATE
This petition is filed within sixty days of obtaining those results and those test results are filed with this petition. Attached is a copy of the notice of the test results.
6. The scientific evidence described in paragraph number 4 above will prove that no rational trier of fact would have found me to be guilty beyond a reasonable doubt of the charge described above because
_______________________________________________________________________________________________
_______________________________________________________________________________________________
[ ] ATTACHED ADDITIONAL SHEET(S)
7. Check box if applicable and provide any additional information.
[ ] My conviction became final after June 30, 1996, and the scientific evidence described in paragraph number 4 above was not available for testing under Virginia Code § 9.1-1104 because:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
[ ] ATTACHED ADDITIONAL SHEET(S)
This petition contains all relevant allegations of fact known to me at this time and all previous records, applications, petitions, appeals, and dispositions relating to this matter are attached. In support of this petition, the following documents are attached:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
[ ] ATTACHED ADDITIONAL SHEET(S)
8. I understand that this petition must contain all relevant allegations of fact that are known to me at this time. I understand that it must include all previous records, applications, petitions, appeals, and their dispositions related to this conviction, as well as a copy of any test results of the scientific evidence described above. I understand that if this petition is not complete, this Court may dismiss the petition or return the petition to me pending the completion of such form. I understand that I am responsible for all statements contained in this petition. I understand that any knowingly or willfully made false statement is a ground for prosecution and conviction of perjury as provided in Virginia Code § 18.2-434.I understand that this Court will not accept this petition unless it is accompanied by a duly executed return of service verifying that a copy of this petition and all attachments have been served on the attorney for the Commonwealth of the jurisdiction where the conviction occurred and on the Attorney General of Virginia.
9. Check box if claiming in forma pauperis status and seeking to file this petition without payment of fees.
[ ] I claim in forma pauperis status and I request that this Court accept this petition without the payment of filing fees. I affirm under oath that I am eligible for in forma pauperis status and I have attached the completed affidavit to this effect.
Based on the above, I petition this Court pursuant to the provisions of Chapter 19.2 of Title 19.2 of the Code of Virginia for a writ of actual innocence.
| ___________________________________ | ___________________________________ |
| DATE | SIGNATURE OF PETITIONER |
| FOR NOTARY PUBLIC'S USE ONLY: | |
| State of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [ ] City [ ] County of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | |
| Acknowledged, subscribed and sworn to before me this . . . . . . . . . . . . day of . . . . . . . . . . . . . . . , 20 . . . . . . . . . . . | |
| . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | ________________________________________________ |
| NOTARY REGISTRATION NUMBER | NOTARY PUBLIC |
| (My commission expires: ..................................... ) | |
AFFIDAVIT IN FORMA PAUPERIS
The petitioner, ____________________________________________________ , being duly sworn, says,
1. I am unable to pay for counsel to prosecute this action;
2. My assets amount to a total of $ ___________________________________________
| ___________________________________ | ___________________________________ |
| DATE | SIGNATURE OF PETITIONER |
| FOR NOTARY PUBLIC'S USE ONLY: | |
| State of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [ ] City [ ] County of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | |
| Acknowledged, subscribed and sworn to before me this . . . . . . . . . . . . day of . . . . . . . . . . . . . . . , 20 . . . . . . . . . . . | |
| . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | ________________________________________________ |
| NOTARY REGISTRATION NUMBER | NOTARY PUBLIC |
| (My commission expires: ..................................... ) | |
Va. Sup. Ct. Form 11