Uniform Application For Post-Conviction Relief - State Of Louisiana Supreme Court Page 5
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7omitted from a prior application.
This application will provide space for you to explain the reasons why you failed to raise your claims in the
proceedings leading to conviction, or failed to urge the claim on appeal, or failed to include the claim in a prior
application.
CLAIM I
Claim:
_____________________________________________________________________________________
(a) Supporting FACTS (tell your story briefly without citing cases or law):
____________________________________________________________________________________
(b) List names and addresses of witnesses who could testify in support of your claim. If you cannot do so,
explain why:
____________________________________________________________________________________
(c) If you failed to raise this ground in the trial court prior to conviction, on appeal or in a prior application,
explain why: _____________________________________________________________________________
CLAIM II
Claim:
_____________________________________________________________________________________
(a) Supporting FACTS (tell your story briefly without citing cases or law):
____________________________________________________________________________________
(b) List names and addresses of witnesses who could testify in support of your claim. If you cannot do so,
explain why:
____________________________________________________________________________________
(c) If you failed to raise this ground in the trial court prior to conviction, on appeal or in a prior application,
explain why: _____________________________________________________________________________
CLAIM III
Claim:
_____________________________________________________________________________________
(a) Supporting FACTS (tell your story briefly without citing cases or law):
____________________________________________________________________________________
(b) List names and addresses of witnesses who could testify in support of your claim. If you cannot do so,
explain why:
____________________________________________________________________________________
(c) If you failed to raise this ground in the trial court prior to conviction, on appeal or in a prior application,
explain why: _____________________________________________________________________________
You may attach additional pages setting forth the required information (above) if additional claims are
asserted.
A. Do you have in a state or federal court any petition or appeal now pending as to the judgment challenged?
Yes [ ] No [ ] If "yes", name the court
______________________________________________________________________________________
B. Do you have any future sentence to serve after you complete the sentence imposed by the judgment
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