Uniform Application For Post-Conviction Relief - State Of Louisiana Supreme Court Page 2

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PETITION
1. Name and location of court which entered the judgment of conviction challenged
______________________________________________________________________________
2. Date of judgment of conviction ___________________________________________________________
3. Length of sentence _____________________________________________________________________
4. Nature of offense involved (all counts) ______________________________________________________
5. What was your plea? (check one)
(a) Not guilty ( )
(b) Guilty ( )
(c) Not guilty and not guilty by reason of insanity ( )
If you entered a guilty plea to one or more counts and not guilty to other counts, give details
____________________________________________________________________________________
(d) Name and address of the lawyer representing you at your plea (if you had no lawyer, please
indicate)
________________________________________________________________________________
(e) Was the lawyer appointed ( ) or hired ( )? (check one)
6. Kind of trial: (check one)
(a) Jury ( )
(b) Judge only ( )
7. (a) Name and address of the lawyer representing you at your trial:
______________________________________________________ ________________________________
(b) Was the lawyer appointed ( ) or hired ( )? (check one)
8. Did you testify at the trial? Yes ( ) No ( )
9. (a) Give the name and address of the lawyer who represented you at sentencing for the conviction being
attacked herein. ___________________________________________________________________________
(b) Was the lawyer appointed ( ) or hired ( )? (check one)
10. Did you appeal from the judgment of conviction? Yes ( ) No ( )
11. If you did appeal, give the following information:
(a) Citation, docket number, and date of written opinion by the Supreme Court (if known)
_________________________________________________________________________________
(b) Name and address of lawyer representing you on appeal:

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