(volume number, Washington Appellate Reports or

_____________________________________________.

Washington Reports, and page number)

     6. Since my conviction I have ___ have not ___ asked a court for some relief from my sentence other than I have already written above. (If the answer is that I have asked), the court I asked was ____________________________

_____________________________________________.

(name of court or courts in which relief was sought)

Relief was denied on _____________________________________________.

(date of decision or, if more than one, dates of all decisions)

     7. (If I have answered in question 6 that I did ask for relief), the name of my lawyer in the proceeding mentioned in my answer to question 6 was _____________________________________________.

(name and address if known; if none, write "none")

     8. If the answers to the above questions do not really tell about the proceedings and the courts, judges and attorneys involved in your case, tell about it here: _____________________________________________

_____________________________________.

B. GROUNDS FOR RELIEF

     (If I claim more than one reason for relief from confinement, I attach sheets for each reason separately, in the same way as the first one. The attached sheets should be numbered "First Ground", "Second Ground", "Third Ground", etc.). I claim that I have ______ (number) reason(s) for this court to grant me relief from the conviction and sentence described in Part A.

     _____________________ Ground

     (First, Second, etc.)

     1. I should be given a new trial or released from confinement because (Here state legal reasons why you think there was some error made in your case which gives you the right to a new trial or release from confinement.): _____________________________________________

_______________________________.

     2. The following facts are important when considering my case (After each fact statement, put the name of the person or persons who know the fact and will support your statement of the fact. If the fact is already in the record of your case, indicate that, also.): _____________________________________________

_______________________________.

     3. The following reported court decisions (include citations if possible) in cases similar to mine show the error I believe happened in my case (If none are known, state "None known".): ________________________________

_____________________________________________

_______________________________.

     4. The following statutes and constitutional provisions should be considered by the court (If none are known, state "None known".):

_____________________________________________

_______________________________.

     5. This petition is the best way I know to get the relief I want, and no other way will work as well because ________

_____________________________________________

_______________________________.

C. STATEMENT OF FINANCES

     If you cannot afford to pay the filing fee or cannot afford to pay an attorney to help you, fill this out. If you have enough money for these things, do not fill out this part of the form.

     1. I do ___ do not ___ ask the court to file this without making me pay the filing fee because I am so poor I cannot pay the fee.

     2. I have a spendable balance of $______ in my prison or institution account.

     3. I do ___ do not ___ ask the court to appoint a lawyer for me because I am so poor I cannot afford to pay a lawyer.

     4. I am ___ am not ___ employed. My salary or wages amount to $______ a month. My employer is __________

_____________________________________________

_________________.

(name and address)

     5. During the past 12 months I did ___ did not ___ get any money from a business, profession or other form of self-employment. (If I did, it was _______________________

                                   (kind of self employment)

and the total income I got was $______.)

     6. During the past 12 months, I

     did     did not     get any rent payments. If so, the total

                         amount I got was $__________.

     ___ ___     get any interest. If so, the total

                         amount I got was $__________.

     ___ ___     get any dividends. If so, the total

                         amount I got was $__________.

     ___ ___     get any other money. If so, the

                         amount of money I got was

                         $__________.

     7. ___ ___     have any cash except as said in

                         answer 2. If so, the total amount of

                         cash I have is $__________.

     ___ ___     have any savings accounts or

                         checking accounts. If so, the amount

                         in all accounts is $__________.

     ___ ___     own stocks, bonds, or notes. If so,

                         their total value is $__________.

     8. List all real estate and other property or things of value which belong to you or in which you have an interest. Tell what each item of property is worth and how much you owe on it. Do not list household furniture and furnishings and clothing which you or your family need.

Items Value

______________________________________________________________________________________________________________________________________________________________________________________________________________________________

     9. I am ___ am not ___ married. If I am married, my wife or husband's name and address is _____________

_____________________________________________.

     10. All of the persons who need me to support them are listed here.

Name and Address Relationship Age

__________________________________________________________________________________________________________________________________________________________________________________________

     11. All the bills I owe are listed here.

Name of creditor Address Amount

you owe money to

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

D. REQUEST FOR RELIEF

     I want this court to:

     ___ vacate my conviction and give me a new trial

     ___ vacate my conviction and dismiss the criminal charges against me without a new trial

     ___ other (specify) ________________________________________________________________

E. OATH OF PETITIONER

THE STATE OF WASHINGTON          )

                                             ) ss.

County of _________________           )

     After being first duly sworn, on oath, I depose and say: That I am the petitioner, that I have read the petition, know its contents, and I believe the petition is true.

___________________________________

[sign here]

     SUBSCRIBED AND SWORN to before me this ___ day of __________.

___________________________________

Notary Public in and for the State

of Washington, residing at ________

     If a notary is not available, explain why none is available and indicate who can be contacted to help you find a notary: ___________________________________ __________________________________________________________

Then sign below:

     I declare that I have examined this petition and to the best of my knowledge and belief it is true and correct.

                    _________________________[date].

                    _________________________

                              [sign here]