Uniform Application For Post-Conviction Relief - State Of Louisiana Supreme Court (Page 6 of 7) in pdf

Uniform Application For Post-Conviction Relief - State Of Louisiana Supreme Court Page 6

challenged? Yes [ ] No [ ]

(1) If so, give name and location of court which imposed sentence to be served in the future:

_________________________________________________________________________________

(2) Give date and length of sentence to be served in the future:

___________________________________________________________________________________

(3) Have you filed, or do you contemplate filing, any petition attacking the judgment which imposed the

sentence to be served in the future? Yes [ ] No [ ]

C. If a copy of the court order sentencing you to custody is not attached, explain why.

_______________________________________________________________________________________

WHEREFORE, petitioner prays that the Court grant petitioner relief to which he may be entitled.

___________________________________

Signature of Petitioner

___________________________________

Day/Month/Year

APPLICATION FOR APPOINTMENT OF COUNSEL

I am unable to employ counsel to represent me in this matter because I have no assets or funds except:

_____________________________________________________________________________________

(Write "None" above if you have nothing; otherwise, list your assets including funds in prison accounts.)

___________________________________

Signature of Petitioner

AFFIDAVIT

STATE OF LOUISIANA

PARISH OF ________

____________________________________________, being first duly sworn says that he has read the

(Name of Petitioner)

foregoing application for post-conviction relief and swears or affirms that all of the information therein is

true and correct. He further swears or affirms that he is unable to employ counsel because he has no assets or

funds which could be used to hire an attorney except as listed above. [Delete reference to appointment of

counsel if inapplicable.]

__________________________________

Signature of Petitioner

SWORN TO AND SUBSCRIBED before me this ______ day of ________, 19___.

__________________________________________

Notary Public or other person authorized to administer an oath.

Uniform Application For Post-Conviction Relief - State Of Louisiana Supreme Court Page 6