Monday, March 16, 2020

Clemency NJ Section 10A:16-8.2

Clemency NJ
     Section 10A:16-8.2 - Petition for executive clemency(a) The petition for executive clemency may be initiated either by the inmate or the Administrator of the correctional facility.(b) The inmate who wishes to apply for executive clemency shall obtain and complete Form Petition of Executive Clemency. The form is available by contacting the State Parole Board. The completed form shall be forwarded to the Administrator for submission to the Office of the Commissioner or designee.(c) The Administrator or designee may complete Form Petition for Executive Clemency on behalf of an inmate.
N.J. Admin. Code § 10A:16-8.2


STATE OF NEW JERSEY 
PETITION FOR EXECUTIVE CLEMENCY 
INSTRUCTIONS: All questions must be answered in full and printed legibly in ink or typed. In the event that this form does not provide sufficient space for any answer, attach additional sheets and number your answer accordingly. If you are confined in a correctional facility, this form must be completed and forwarded to the Administrator of the correctional facility where you are confined. In all other cases the completed petition should be mailed to: 
New Jersey State Parole Board Attn: Clemency Unit
P.O. Box 862
Trenton, New Jersey 08625 
NOTE: It would be helpful if you support this petition with documentation (i.e.; copies of high school diploma, college transcripts, marriage license, proof of employment, proof of citizenship, if applicable etc.); however, it is not necessary that you provide these documents. 
Applicant Name: Address: Telephone #: 
If you are represented by an attorney or other party, please indicate to whom all communications relating to this petition should be addressed. 
Attorney Name: Address: Telephone #: 
  1. Type of Executive Clemency sought by applicant (check one below)¨Pardon ¨Remission of Fine 
¨Commutation of Sentence ¨Other 
  1. List any other names by which you have been known: 
Page 1 of 12 
rev. 6/11 
3. What is your reason for seeking clemency? 
  1. State briefly why you believe you should be granted clemency: 
  2. Date of Birth: SBI No.:
    Place of Birth: Driver's License No.: 
County of Birth: 
Social Security No.: 
  1. If you were not born in the United States, complete below. When did you first enter the United States? 
Port of entry:
Under what name did you enter?
Are you a naturalized citizen of the United States? 
¨Yes Date of Naturalization:¨No Give alien registration number: 
Are you presently under an order for deportation or are deportation proceedings pending? ¨Yes ¨No
Are you under an immigration detainer? 
¨Yes ¨No 
  1. For each member of your family give the following information: 
Name 
(if deceased, give age at death) 
Address 
Occupation 
Father 
Mother 
Brothers 
Sisters 
Page 2 of 12 
rev. 6/11 
  1. Were your parents ever separated or divorced? ¨Yes ¨No 
  2. Please indicate the highest level of education you attended and the dates. 
  3. Were you ever married? (include civil union) ¨Yes ¨No (If "yes", please provide) 
Did any marriage or civil union result in annulment, legal separation, or divorce? ¨Yes ¨No 
(If "yes", please provide) 
School 
Date Attended
Date Completed 
Name Used 
Maiden Name 
Date Married/ Civil Union 
Place of Marriage/ Civil Union 
Name of Court
Location of Court 
Date of Decree 
Type of Decree 
Conditions of Decree 
11. Do you have children? ¨Yes ¨No If yes, how many? _________
Give the following information about your children and any others who are 
dependent upon you for support: 
Name 
Address 
Date of Birth
Page 3 of 12 
rev. 6/11 
12. List each job you have held and give the following information regarding each position: 
Employer:
Date Employed: Salary: 
Employer:
Date Employed: Salary: 
Employer:
Date Employed: Salary: 
Position Held: Reason for Leaving: 
Position Held: Reason for Leaving: 
Position Held: Reason for Leaving: 
(Please use a separate sheet of paper for additional employers) 
  1. Religious affiliation: Name of Church: 
  2. Provide names and addresses of any social clubs, unions, fraternal groups, or other community organizations to which you belong; include dates of participation. 
15. Have you ever served in the United States Armed Forces? 
(If "yes", please provide) 
What branch did you serve?
Date and Place of entry:
Serial, service or identification number: Highest rank: 
¨Yes ¨No 
Discharge:¨Honorable ¨Dishonorable ¨General ¨Bad Conduct ¨Other (explain)
Page 4 of 12 
rev. 6/11 
Date of discharge: (Provide official discharge documents) Do you have a disability that is recognized by the Veteran's Administration? 
¨Yes ¨No
If you do, describe the degree of your disability and indicate amount of financial 
benefit received per month: 
16. Record of arrests: (List each time you were arrested and whether a conviction resulted. If you are uncertain of any details, your statement to that effect may be grounds for rejection of this petition for falsification. If possible, provide any arrest reports or court documents [i.e., Pre-Sentence Investigation Report and/or Judgment of Conviction]. If you are not in possession of these documents, our office will request them from the court.) 
Arrest Date: Location of Court: 
Sentence:
(Confinement, Probation, Fine, etc.) 
Circumstances of Crime: 
Arrest Date: Location of Court: 
Sentence:
(Confinement, Probation, Fine, etc.) 
Circumstances of Crime: 
Arrest Date: Location of Court: 
Sentence:
(Confinement, Probation, Fine, etc.) 
Circumstances of Crime: 
Date of Sentence: Crime(s): 
Date of Sentence: Crime(s): 
Date of Sentence: Crime(s): 
Page 5 of 12 
rev. 6/11 
Arrest Date: Date of Sentence: Location of Court: Crime(s): 
Sentence:
(Confinement, Probation, Fine, etc.) 
Circumstances of Crime: 
Arrest Date: Date of Sentence: Location of Court: Crime(s): 
Sentence:
(Confinement, Probation, Fine, etc.) 
Circumstances of Crime: 
(Please use separate sheets of paper for additional arrests/convictions) 
17. List each instance of incarceration in a correctional facility: 
Name of Facility 
Location of Facility 
Date Entered 
Date Released
18. Have you ever appealed the conviction or sentence for which you are seeking 
clemency?¨Yes ¨No (If "yes", please provide) 
Name of Court
Docket Number
Date of Disposition of Appeal 
Page 6 of 12 
rev. 6/11 
Are any appeals currently pending? ¨Yes ¨No (If "yes", please provide) 
What jurisdiction?
Have you ever filed a motion for post conviction relief? 
¨Yes ¨No 
(If "yes", please provide) 
Have you applied for an expungement? ¨Yes ¨No (If "yes", please provide) 
19. List each instance of parole or probation including (PTI) Pre-Trial Intervention Program (PTI) and Conditional Discharge (CD): 
Disposition 
Date of Disposition 
Disposition 
Date of Disposition 
Type of Supervision (Parole, Probation, PT, CD) 
Date Supervision Began 
District Office 
Date of Discharge 
List each instance of revocation of parole or probation: 
Page 7 of 12 
rev. 6/11 
  1. Have you ever had a court issue a restraining order against you for a domestic violence-related incident? ¨Yes ¨No 
(If "yes". please provide) 
Details of restraining order: 
  1. Do you have any open, pending court matters? ¨Yes ¨No (If "yes". please provide) 
  2. Have you ever been hospitalized for treatment of a psychological disorder? ¨Yes ¨No 
(If "yes". please provide) 
Court (Superior or Municipal) 
Offense 
Date of Arrest
Institution 
Date Entered 
Date Released
23. Please provide a detailed history of your alcohol and/or drug use. 
Substance(s) of choice: 
Frequency of use: 
Age started: 
Amount of money spent on use: 
Ever sold drugs? ¨Yes ¨No 
Ever charged with Driving Under the Influence? 
(If "yes". please provide) 
Disposition:
¨Yes ¨No 
Page 8 of 12 
rev. 6/11 
Have you ever received treatment for alcohol and/or drug addiction? ¨Yes ¨No 
(If "yes", please provide information for each treatment you experienced) Type of treatment: (Check all that apply) 
¨Inpatient¨Narcotics Anonymous (NA) 
Name of treatment facility: Location:
Number of days in treatment: Reason for discharge: 
¨Outpatient¨Alcohol Anonymous (AA) 
Date entered: Date discharged: 
(Please provide additional pages for each instance of treatment)
Did you successfully complete the program? ¨Yes ¨No (If "no", please indicate reason for failure to complete the program) 
Explanation:
Did the court ever order treatment? ¨Yes ¨No (If "yes", please provide for each order) 
Court 
Date 
24. Have you ever returned to active drug or alcohol use after attending Alcoholics Anonymous/Narcotics Anonymous or after having received professional treatment? 
¨Yes ¨No (If "yes", please provide) 
Details of relapse: 
Page 9 of 12 
rev. 6/11 
Have you ever participated in any alcohol or drug treatment programs during your present confinement? ¨Yes ¨No 
(If "yes", please provide) 
If possible, provide copy of certificate of completion to all programs. 
  1. List any other institutional programs you are currently participating in or completed during your present confinement: 
  2. Have you ever previously applied to the Governor of New Jersey for Executive Clemency? 
¨Yes ¨No (If "yes", please provide) 
  1. This petition is subject to a complete investigation. However, the petitioner has the right to request that the State refrain from contacting individuals such as employers or others. Do you desire any such limitation to be placed on the 
investigation? ¨Yes ¨No (If "yes", please provide) 
List of those not to be contacted: 
Name of Program 
Dates of Participation 
Date of Application 
Type of Clemency Sought 
Disposition 
Date of Disposition 
Page 10 of 12 
rev. 6/11 
If this petition is for a Pardon, attach testimonials (letters of support) addressed to the Governor from at least two (2) persons who have knowledge of your community adjustment during the past two (2) years and, if possible, who are aware of the crime(s) for which clemency is sought; or attach a statement explaining why you cannot furnish such testimonials. If this petition is for a Commutation of Sentence, testimonials are not required. 
Petitioner's Signature: 
Sworn and subscribed to before me this day of 20 
at
in the County of State of 
(Notary Public or other authorized to take oaths) 
Date:
NOTE: It is your responsibility to notify our office of any changes in your address or telephone number. 
Page 11 of 12 
rev. 6/11 
State of New Jersey NEW JERSEY STATE PAROLE BOARD P.O. BOX 862 TRENTON,NEWJERSEY 08625 TELEPHONE NUMBER: (609) 292-4257 
PHILIPD.MURPHY
Governor
SHEILA Y. OLIVER 
Lt. Governor 
To Whom It May Concern: 
I, 
(Applicant’s name) 
agency, insurance company, current or former employer(s), State and Federal income tax bureaus, educational institution, or any other named agency to furnish the New Jersey State Parole Board with any requested information and/or documents pertaining to myself, for the purpose of completing a confidential community investigation which is required for processing my application for Executive Clemency. 
____________________________________ ______________ Applicant Signature Date 
____________________________________ Applicant Identification No. (SS#; SBI #; etc.) 
c: Copy for File Copy to Provider 
Page 12 of 12 
hereby authorize any law enforcement 
SAMUEL J. PLUMERI, JR. 
Chairman
rev. 6/11 

source https://www.nj.gov/parole/docs/executiveClemencyApplication.pdf