                                 CODE OF VIRGINIA

FORM AND CONTENTS OF PETITION FILED BY PRISONER (§ 8.01-655)

A. Every petition filed by a prisoner seeking a writ of habeas corpus must be
filed on the form set forth in subsection B. The failure to use such form and to
comply substantially with such form shall entitle the court to which such
petition is directed to return such petition to the prisoner pending the use of
and substantial compliance with such form. The petitioner shall be responsible
for all statements contained in the petition and any false statement contained
therein, if the same be knowingly or wilfully made, shall be a ground for
prosecution and conviction of perjury as provided for in &#xA7; 18.2-434.

B. Every petition filed by a prisoner seeking a writ of habeas corpus shall be
filed on a form to be approved and provided by the office of the Attorney
General, the contents of which shall be substantially as follows:
			IN
THE&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#x2026; COURT
			&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8
230;&#8230;..&#x2026;
			Full name and prisonerCase
No&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.&#x2026;
			number (if any) of(To be supplied by
			Petitionerthe Clerk of the
			-vs-Court)
			&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8
230;&#8230;..&#x2026;
			&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8
230;&#8230;..&#x2026;
			Name and Title of Respondent
			PETITION FOR WRIT OF HABEAS CORPUS
			Instructions&#8211;Read Carefully
			In order for this petition to receive consideration by the Court, it must be
legibly handwritten or typewritten, signed by the petitioner and verified before
a notary or other officer authorized to administer oaths. It must set forth in
concise form the answers to each applicable question. If necessary, petitioner
may finish his answer to a particular question on an additional page. Petitioner
must make it clear to which question any such continued answer refers. The
petitioner may also submit exhibits.
			Since every petition for habeas corpus must be sworn to under oath, any false
statement of a material fact therein may serve as the basis of prosecution and
conviction for perjury under &#xA7;&#xA0;18.2-434. Petitioners should,
therefore, exercise care to assure that all answers are true and correct.
			When the petition is completed, the original and two copies (total of
			three) should be mailed to the clerk of the court. The petitioner shall keep
one copy.
			NOTICE
			The granting of a writ of habeas corpus does not entitle the petitioner to
dismissal of the charges for conviction of which he is being detained, but may
gain him no more than a new trial.
			&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8
230;&#8230;..&#x2026;
			Place of
detention:&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.&#x2026;

A. Criminal Trial

   1. Name and location of court which imposed the sentence from which you seek
   relief:&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&
   #8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#
   8230;&#8230;&#8230;..&#x2026;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&
   #8230;&#8230;&#8230;&#8230;..&#x2026;..&#x2026;

   2. The offense or offenses for which sentence was imposed (include indictment
   number or numbers if known):
   a&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026;
   b&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026;
   c&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026;

   3. The date upon which sentence was imposed and the terms of the sentence:
   a&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026;
   b&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026;
   c&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026;

   4. Check which plea you made and whether trial by jury: Plea of guilty:
   &#8230;&#8230;.; Plea of not guilty:&#8230;&#8230;.; Trial by
   jury:&#8230;&#8230;; Trial by judge without jury:&#8230;&#x2026;

   5. The name and address of each attorney, if any, who represented you at your
   criminal
   trial:&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#
   8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8
   230;&#8230;&#8230;..&#x2026;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&
   #8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#
   8230;&#8230;&#8230;&#8230;&#8230;&#8230;..&#x2026; 6. Did you appeal the
   conviction?&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#82
   30;&#8230;&#8230;..&#x2026; 7. If you answered &#8220;yes&#8221; to 6, state:
   the result and the date in your appeal or petition for certiorari:
   a&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026;
   b&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026; citations of the appellate court opinions or orders:
   a&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026;
   b&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026;

   8. List the name and address of each attorney, if any, who represented you on
   your
   appeal:&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&
   #8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#
   8230;&#8230;&#8230;..&#x2026;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&
   #8230;&#8230;&#8230;&#8230;&#8230;&#8230;..&#x2026;

B. Habeas Corpus

   9. Before this petition did you file with respect to this conviction any other
   petition for habeas corpus in either a State or federal
   court?&#8230;&#8230;&#x2026; 10. If you answered &#8220;yes&#8221; to 9, list
   with respect to each petition: the name and location of the court in which
   each was filed:
   a&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;..&#x2026;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.&#x2
   026;
   b&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026; the disposition and the date:
   a&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026;
   b&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026; the name and address of each attorney, if any, who represented you on
   your habeas corpus:
   a&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026;
   b&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026;

   11. Did you appeal from the disposition of your petition for habeas corpus?
   12. If you answered &#8220;yes&#8221; to 11, state: the result and the date of
   each petition:
   a&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026;
   b&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026; citations of court opinions or orders on your habeas corpus petition:
   a&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026;
   b&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026; the name and address of each attorney, if any, who represented you on
   appeal of your habeas corpus:
   a&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026;
   b&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026;

C. Other Petitions, Motions or Applications

   13. List all other petitions, motions or applications filed with any court
   following a final order of conviction and not set out in A or B. Include the
   nature of the motion, the name and location of the court, the result, the
   date, and citations to opinions or orders. Give the name and address of each
   attorney, if any, who represented you.
   a&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026;
   b&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026;
   c&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026;

D. Present Petition

   14. State the grounds which make your detention unlawful, including the facts
   on which you intend to rely:
   a&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026;
   b&#8230;&#8230;&#8230;&#8230;&#x2026;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230
   ;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#x2026;
   c&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026; 15. List each ground set forth in 14, which has been presented in any
   other proceeding:
   a&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026;
   b&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026;
   c&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026; List the proceedings in which each ground was raised:
   a&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026;
   b&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026;
   c&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026; 16. If any ground set forth in 14 has not been presented to a court,
   list each ground and the reason why it was not:
   a&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026;
   b&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026;
   c&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
   &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
   &#x2026;
   				&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#82
   30;&#8230;&#8230;&#8230;&#8230;&#x2026;
   				Signature of Petitioner
   				&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#82
   30;&#8230;&#8230;&#8230;&#8230;&#x2026;
   				Address of Petitioner
   				STATE OF VIRGINIA
   				CITY/COUNTY
   OF&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230
   ;..&#x2026;
   				The petitioner being first duly sworn, says:

   1. He signed the foregoing petition;

   2. The facts stated in the petition are true to the best of his information
   and belief.
   				&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#82
   30;&#8230;&#8230;&#8230;&#8230;&#x2026;
   				Signature of Petitioner
   				Subscribed and sworn to before me
   				this&#8230;.&#x2026; day
   of&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;., 20&#8230;&#x2026;
   				&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#82
   30;&#8230;&#x2026; Notary Public
   				My commission
   expires:&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.&#x2026;
   				The petition will not be filed without payment of court costs unless the
   petitioner is entitled to proceed in forma pauperis and has executed the
   affidavit in forma pauperis.
   				The petitioner who proceeds in forma pauperis shall be furnished, without
   cost, certified copies of the arrest warrants, indictment and order of his
   conviction at his criminal trial in order to comply with the instructions of
   this petition.
   				AFFIDAVIT IN FORMA PAUPERIS
   				STATE OF VIRGINIA
   				CITY/COUNTY
   OF&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..&#x2026;
   				The petitioner being duly sworn, says:

   1. He is unable to pay the costs of this action or give security therefor; 2.
   His assets amount to a total of
   $&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..&#x2026;
   				&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#82
   30;&#8230;&#8230;&#8230;&#8230;&#x2026;
   				Signature of Petitioner
   				Subscribed and sworn to before me
   				this&#8230;.&#x2026; day
   of&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;., 20&#8230;&#x2026;
   				&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#82
   30;&#8230;&#x2026; Notary Public
   				My commission expires:&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#x2026;

HISTORY: Code 1950, § 8-596.1; 1968, c. 359; 1977, c. 617.