Form Adm 1501 - Application For Clemency - Florida Office Of Executive Clemency
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1APPLICATION FOR CLEMENCY
Check box for type of clemency desired. All applications must have the proper court documents attached.
Restoration of Civil Rights for Florida conviction
Specific Authority to Own, Possess or Use Firearms
(Eligible 8 years after completion of sentence)
Restoration of Civil Rights in Florida for Federal,
Full Pardon (Eligible 10 years after completion of sentence
)
Military, or Out-of-State conviction
Pardon Without Firearm Authority
Restoration of Alien Status Under Florida Law
(Eligible 10 years after completion of sentence )
Remission of Fine or Forfeiture
Commutation of Sentence (Use Form “Request for Review”)
If you have applied for a Full Pardon; Pardon Without Firearm Authority; or Specific Authority to Own, Possess or Use Firearms and
are determined ineligible due to not meeting the time requirement, you will be processed for Restoration of Civil Rights. If you have
already received Restoration of Civil Rights, your application will be returned along with a Certificate for Restoration of Civil Rights.
Your signature acknowledges you understand this action. _______________________________________________________
SIGNATURE
PLEASE PRINT CLEARLY
Name When Convicted: ________________________________________________________________________________________________
Current Name: ______________________________________Other Names Used: _________________________________________________
Date of Birth: ___________________ Race: _____ Sex:
Male
Female
Driver License #: _____________________________________
U.S. Citizen?
Yes
No - Alien Registration ________________________ Social Security #: _____________________________________
Home Address: _______________________________________________________________________________________________________
Street
City
County
State
Zip
Mailing Address: _____________________________________________________________________________________________________
Street
City
County
State
Zip
Home Telephone #: _______________________________________Cellular Telephone #: __________________________________________
E-mail Address: ______________________________________________________________________________________________________
PRISON/PROBATION #: ___________________________
CONVICTIONS: (Please list each conviction and provide court documents for each conviction. If you have more than two convictions, please
attach a separate sheet of paper listing all the required information.) YOU DO NOT NEED TO FILL OUT A SEPARATE APPLICATION
FOR EACH CONVICTION.
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
Court_________________ County/State___________________ Date Convicted ____________ Date Sentenced__________________________
What was your sentence? _______________________________________________________________________________________________
Date you completed/expired your sentence: _________________ (Please Circle one of the following: Prison Jail Release Parole Probation)
_____________________________________________________________
________________________________________________
Signature
Date
YOU DO NOT NEED AN ATTORNEY FOR THIS PROCESS. Do not list the attorney who represented you during the criminal
proceedings. If you have chosen to be represented by an attorney for the clemency process, please provide the Attorney Name, Address &
Telephone Number.
____________________________________________________________________________________________________________________
Attorney Name
Address
Telephone Number
Attach a certified copy of the following for EACH CONVICTION: charging indictment/information; judgment; and
sentence/community control/probation order.
APPLICATIONS SUBMITTED WITHOUT THE PROPER COURT DOCUMENTS
WILL NOT BE ACCEPTED AND WILL BE RETURNED.
This application form and Rules of Executive Clemency are also available on the internet at: https://fpc.state.fl.us/Clemency.htm
Mailing address:
Office of Executive Clemency
Form ADM 1501
4070 Esplanade Way
Updated 03/09/2011
Tallahassee, FL 32399-2450
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