The Mississippi Clemency Form is an official application that individuals can submit to request clemency from the Governor of Mississippi. This form serves as a means to seek a pardon, commutation of sentence, or restoration of civil rights. Completing the form is essential for consideration, but it does not guarantee that clemency will be granted.
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The Mississippi Clemency form serves as a critical tool for individuals seeking clemency from the state government. This application allows applicants to request various forms of clemency, including pardons, commutations of sentences, and restoration of civil rights. Completing the form requires detailed personal information, such as the applicant's name, social security number, and date of birth, as well as specifics about their criminal history. The form also requests information about employment history, marital status, and dependent children, all of which help to paint a complete picture of the applicant's circumstances. Additionally, applicants must provide a letter outlining the extenuating circumstances that support their request, along with letters of recommendation from non-family members. It's important to note that submitting the application does not guarantee that clemency will be granted; rather, it opens the door for consideration. Clear instructions guide applicants on how to submit the form, emphasizing the importance of accuracy and completeness in the information provided.
Filling out the Mississippi Clemency form can be a complex process, and several common mistakes can hinder an applicant's chances of success. One significant error is failing to provide complete information. Each section of the form requires specific details, such as names, addresses, and dates. Omitting any of this information can lead to delays or a denial of the application.
Another frequent mistake is not including all criminal charges or convictions. The form explicitly states that applicants must include all past and pending charges, regardless of conviction status. Many people mistakenly leave out minor offenses or pending cases, which can negatively impact their application.
Inaccurate or inconsistent information is also a common pitfall. If the details provided do not match official records, this inconsistency can raise red flags. Applicants should double-check the accuracy of their social security numbers, dates of birth, and other critical information to ensure everything aligns with official documents.
Many applicants neglect to include the required supporting documents. The clemency application must be accompanied by a letter detailing the extenuating circumstances for the request. Additionally, letters of recommendation from non-family references are essential. Failing to provide these documents can result in an incomplete application.
Another mistake involves not specifying the type of clemency being sought. The form offers options such as pardon, commutation of sentence, or restoration of civil rights. Applicants should clearly indicate which type they are requesting to avoid confusion during the review process.
Some individuals overlook the importance of addressing past disciplinary actions while incarcerated. The form requests specific instances of any disciplinary actions received. Not providing this information can be perceived as withholding details, which may adversely affect the application.
Lastly, applicants often forget to sign and date the application. This step is crucial, as the form states that the applicant must swear or affirm that the information is complete and accurate. An unsigned application may be considered invalid, leading to automatic rejection.
STATE OF MISSISSIPPI
OFFICE OF THE GOVERNOR
APPLICATION FOR CLEMENCY
The applicant MUST complete the application for clemency (use extra paper if necessary.)
CONSIDERATION OF THIS APPLICATION DOES NOT NECESSARILY RESULT IN THE CLEMENCY REQUEST BEING GRANTED.
___ Pardon
___ Commutation of Sentence
___ Restoration of Civil Rights
1. NAME:_________________________________________________________________________________
Last
First
Middle
2. SOCIAL SECURITY #
3. DATE OF BIRTH_________________________
4.DEPARTMENT OF CORRECTIONS NUMBER:_______________________________________________
5.ADDRESS:______________________________________________________________________________
StreetCity
___________________________________________ 6. PHONE NUMBER:____________________
State
Zip
7. MARITAL STATUS: ____________________
8. SPOUSE'S NAME:___________________________
9. SPOUSE'S ADDRESS: ____________________________________________________________________
Street
City
10. NAMES AND AGES OF DEPENDENT
CHILDREN:___________________________________________
__________________________________________________________________________________________
11.CRIMINAL CHARGES OR CONVICTIONS (Include ALL past and pending charges regardless of conviction. Include felony(s) and/or misdemeanor(s), excluding traffic violations - use extra paper if necessary):
a)__________________________________________________________________________________
Charge
Conviction Received
____________________________
___________________________________
Date Convicted
County of Court
Judge
Prosecutor
Defense Attorney
Sentence
Period of Incarceration
Place Incarcerated
b)__________________________________________________________________________________
12. If ever incarcerated, state every instance the applicant received disciplinary action (be specific):
13. Conviction(s) for which the pardon is being sought:_____________________________________________
14. List Applicant's four most recent employers:
1)__________________________________
_________________________________________
Employer's Name
Employer’s Address
_______________________
___________________
______________________________
Supervisor
Period Employed
Reason for Leaving
2)__________________________________
3)__________________________________
4)__________________________________
15.Military record (include branch of military, date of service and type of discharge):
____________________________________________________________________________________
16.Names and addresses of three non-family references:
1)_________________________________________________________________________________
2)__________________________________________________________________________________
3)__________________________________________________________________________________
17.Has the Applicant ever received clemency:____________________
18.Has the Applicant ever been on parole? ____________________ If yes, has the Applicant ever been found in violation of any terms or conditions of the parole?____________________ If yes, explain on extra paper.
19.Has the Applicant ever been on probation? ___________________ If yes, state the name(s) and address(es) of the Applicant's probation officer(s):
20.Has the Applicant ever been found in violation of any terms or conditions of the probation? _______________ If yes, explain on a separate sheet of paper.
21.In a separate letter, which must accompany this application, state the extenuating circumstances supporting the basis for the clemency request.
22.Letters of recommendation in support of the request for clemency must accompany this application. Letters may be submitted from all sources, including but not limited to the following: neighbors, employers, co-workers, pastors, church members, elected officials, judges, prosecutors, family members, etc....
23.Name, address and phone number of person(s) to contact if we need to contact you on an emergency basis.
I SWEAR OR AFFIRM THAT THE INFORMATION REPORTED IN THIS APPLICATION FOR CLEMENCY AND ANY ACCOMPANYING MATERIAL IS COMPLETE AND ACCURATE.
_________________________
_____________________________________
Date
Signature
COMPLETION OF THE APPLICATION, WHICH MUST BE IN FULL, MEANS ONLY THAT THE APPLICANT MAY BE CONSIDERED FOR CLEMENCY, NOT THAT ONE WILL BE GRANTED.
Promptly notify us concerning any change of address or change in telephone listing.
Return completed Application for Clemency with letter which states the extenuating circumstances supporting the basis for the clemency request to:
Office of the Governor
Attn: Legal Division
PO Box 139
Jackson, MS 39205-0139
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