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 § 18.2-434.\nB. 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:\nIN THE............................................................… COURT\n..........................................................................…\nFull name and prisonerCase No............................…\nnumber (if any) of(To be supplied by\nPetitionerthe Clerk of \n..........................................................................…\nFull name and prisonerCase No............................…\nnumber (if any) of(To be supplied by\nPetitionerthe Clerk of the\n-vs-Court)\n..........................................................................…\n..........................................................................…\nName and Title of Respondent\nPETITION FOR WRIT OF HABEAS CORPUS\nInstructions--Read Carefully\nIn order for this petition to receive consideration by the Court, it must\nbe legibly handwritten or typewritten, signed by the petitioner and verified\nbefore a notary or other officer authorized to administer oaths. It must set\nforth in concise form the answers to each applicable question. If necessary,\npetitioner may finish his answer to a particular question on an additional\npage. Petitioner must make it clear to which question any such continued\nanswer refers. The petitioner may also submit exhibits.\nSince every petition for habeas corpus must be sworn to under oath, any\nfalse statement of a material fact therein may serve as the basis of\nprosecution and conviction for perjury under § 18.2-434. Since every petition for habeas corpus must be sworn to under oath, any\nfalse statement of a material fact therein may serve as the basis of\nprosecution and conviction for perjury under § 18.2-434. Petitioners should,\ntherefore, exercise care to assure that all answers are true and correct.\nWhen the petition is completed, the original and two copies (total of\nthree) should be mailed to the clerk of the court. The petitioner shall keep\none copy.\nNOTICE\nThe granting of a writ of habeas corpus does not entitle the petitioner to\ndismissal of the charges for conviction of which he is being detained, but may\ngain him no more than a new trial.\n..........................................................................…\nPlace of detention:....................................................…\nA. Criminal Trial\n1. Name and location of court which imposed the sentence from which you\nseek relief:\n..........................................................................…\n....................................................................…..…\n2. The offense or offenses for which sentence was imposed (include\nindictment number or numbers if .......................…\n....................................................................…..…\n2. The offense or offenses for which sentence was imposed (include\nindictment number or numbers if known):\na...................................................................…\nb...................................................................…\nc...................................................................…\n3. The date upon which sentence was imposed and the terms of the sentence:\na...................................................................…\nb...................................................................…\nc...................................................................…\n4. Check which plea you made and whether trial by jury: Plea of guilty:\n.......; Plea of not guilty:.......; Trial by jury:......; Trial by judge\nwithout jury:...…\n5. The name and address of each attorney, if any, who represented you at\nyour criminal trial:\n..........................................................................…\n..........................................................................…\n6. represented you at\nyour criminal trial:\n..........................................................................…\n..........................................................................…\n6. Did you appeal the conviction?......................................…\n7. If you answered 'yes' to 6, state: the result and the date in your\nappeal or petition for certiorari:\na...................................................................…\nb...................................................................…\ncitations of the appellate court opinions or orders:\na...................................................................…\nb...................................................................…\n8. List the name and address of each attorney, if any, who represented you\non your appeal:\n..........................................................................…\n..........................................................................…\nB. Habeas Corpus\n9. Before this petition did you file with respect to this conviction any\nother petition for habeas corpus in either a State or federal court?......…\n10. ........................…\nB. Habeas Corpus\n9. Before this petition did you file with respect to this conviction any\nother petition for habeas corpus in either a State or federal court?......…\n10. If you answered 'yes' to 9, list with respect to each petition: the\nname and location of the court in which each was filed:\na.........................................…......................…\nb...................................................................…\nthe disposition and the date:\na...................................................................…\nb...................................................................…\nthe name and address of each attorney, if any, who represented you on\nyour habeas corpus:\na...................................................................…\nb...................................................................…\n11. Did you appeal from the disposition of your petition for habeas corpus?\n12. If you answered 'yes' to 11, state: the result and the date of each\npetition:\na...................................................................…\nb...................................................................…\ncitations of court esult and the date of each\npetition:\na...................................................................…\nb...................................................................…\ncitations of court opinions or orders on your habeas corpus petition:\na...................................................................…\nb...................................................................…\nthe name and address of each attorney, if any, who represented you on\nappeal of your habeas corpus:\na...................................................................…\nb...................................................................…\nC. Other Petitions, Motions or Applications\n13. List all other petitions, motions or applications filed with any court\nfollowing a final order of conviction and not set out in A or B. Include the\nnature of the motion, the name and location of the court, the result, the\ndate, and citations to opinions or orders. Give the name and address of each\nattorney, if any, who represented Include the\nnature of the motion, the name and location of the court, the result, the\ndate, and citations to opinions or orders. Give the name and address of each\nattorney, if any, who represented you.\na...................................................................…\nb...................................................................…\nc...................................................................…\nD. Present Petition\n14. State the grounds which make your detention unlawful, including the\nfacts on which you intend to rely:\na...................................................................…\nb............…...................................................…\nc...................................................................…\n15. List each ground set forth in 14, which has been presented in any other\nproceeding:\na...................................................................…\nb...................................................................…\nc...................................................................…\nList the proceedings in which each ground was .........…\nb...................................................................…\nc...................................................................…\nList the proceedings in which each ground was raised:\na...................................................................…\nb...................................................................…\nc...................................................................…\n16. If any ground set forth in 14 has not been presented to a court, list\neach ground and the reason why it was not:\na...................................................................…\nb...................................................................…\nc...................................................................…\n.............................................…\nSignature of Petitioner\n.............................................…\nAddress of Petitioner\nSTATE OF VIRGINIA\nCITY/COUNTY OF...................................…\nThe petitioner being first duly sworn, says:\n1. He signed the foregoing petition;\n2. The facts stated in the petition are true to the best of his\ninformation and ................................…\nThe petitioner being first duly sworn, says:\n1. He signed the foregoing petition;\n2. The facts stated in the petition are true to the best of his\ninformation and belief.\n.............................................…\nSignature of Petitioner\nSubscribed and sworn to before me\nthis....… day of........................., 20...…\n....................................…\nNotary Public\nMy commission expires:......................…\nThe petition will not be filed without payment of court costs unless the\npetitioner is entitled to proceed in forma pauperis and has executed the\naffidavit in forma pauperis.\nThe petitioner who proceeds in forma pauperis shall be furnished, without\ncost, certified copies of the arrest warrants, indictment and order of his\nconviction at his criminal trial in order to comply with the instructions of\nthis petition.\nAFFIDAVIT IN FORMA PAUPERIS\nSTATE OF VIRGINIA\nCITY/COUNTY OF.............................…\nThe petitioner being duly sworn, says:\n1. He is unable to pay the costs of this action or give security\ntherefor;\n2. ORMA PAUPERIS\nSTATE OF VIRGINIA\nCITY/COUNTY OF.............................…\nThe petitioner being duly sworn, says:\n1. He is unable to pay the costs of this action or give security\ntherefor;\n2. His assets amount to a total of $....................…\n.............................................…\nSignature of Petitioner\nSubscribed and sworn to before me\nthis....… day of........................., 20...…\n....................................…\nNotary Public\nMy commission expires:..................…\nCode 1950, § 8-596.1; 1968, c. 359; 1977, c. 617.
Virginia Legal Code