MILITARY CLEMENCY PETITION

PETITION TYPE

☐ Post-Trial Clemency Petition to Convening Authority (R.C.M. 1105/1106)
- Must be submitted within 10 days of receiving certified record of trial

☐ Clemency Petition to Clemency and Parole Board
- For sentences including confinement of one year or more

☐ Petition to Secretary of Military Department
- For restoration to duty, remission of sentence, or executive clemency

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SECTION I: PETITIONER INFORMATION

Full Name: [________________________________]

Rank/Grade at Time of Trial: [________________________________]

Current Status: ☐ Confined ☐ On Appellate Leave ☐ Discharged

Branch of Service: ☐ Army ☐ Navy ☐ Air Force ☐ Marine Corps ☐ Coast Guard ☐ Space Force

SSN (Last 4): [____]

Date of Birth: [__/__/____]

Register Number (if confined): [________________________________]

Current Location/Confinement Facility: [________________________________]

Current Contact Address:
[________________________________]
[________________________________]

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SECTION II: COURT-MARTIAL INFORMATION

Type of Court-Martial: ☐ General ☐ Special ☐ Summary

Case Number: [________________________________]

Convening Authority: [________________________________]

Date of Trial: [__/__/____]

Military Judge: [________________________________]

Trial Counsel: [________________________________]

Defense Counsel: [________________________________]

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SECTION III: CHARGES AND FINDINGS

Charges and Specifications

Charge	Article	Specification Summary	Finding
Charge I	Art. [____]	[________________________________]	☐ Guilty ☐ Not Guilty
Charge II	Art. [____]	[________________________________]	☐ Guilty ☐ Not Guilty
Charge III	Art. [____]	[________________________________]	☐ Guilty ☐ Not Guilty

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SECTION IV: SENTENCE ADJUDGED

Date Sentence Announced: [__/__/____]

Adjudged Sentence:

☐ Confinement: [____] Years [____] Months [____] Days
☐ Forfeiture of Pay: $[________] per month for [____] months
☐ Total Forfeitures
☐ Reduction to Grade: [____]
☐ Fine: $[________]
☐ Reprimand
☐ Hard Labor Without Confinement: [____] Days
☐ Restriction: [____] Days
☐ Dismissal (Officers)
☐ Dishonorable Discharge
☐ Bad Conduct Discharge
☐ Death

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SECTION V: CLEMENCY REQUESTED

A. Specific Relief Requested

☐ Disapproval of findings as to Charge [____], Specification [____]
☐ Disapproval of sentence in its entirety
☐ Reduction of confinement from [____] to [____]
☐ Suspension of confinement
☐ Remission of forfeitures
☐ Waiver of automatic forfeitures for dependent support
☐ Disapproval of punitive discharge
☐ Suspension of punitive discharge
☐ Reduction of reduction in grade
☐ Restoration to duty
☐ Parole
☐ Other: [________________________________]

B. Priority of Requested Relief

1. [________________________________]
2. [________________________________]
3. [________________________________]

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SECTION VI: GROUNDS FOR CLEMENCY

A. Legal Errors at Trial

☐ Insufficient evidence to support conviction
☐ Improper admission of evidence
☐ Improper exclusion of evidence
☐ Instructional error
☐ Ineffective assistance of counsel
☐ Unlawful command influence
☐ Other legal errors: [________________________________]

Explanation:
[________________________________]
[________________________________]
[________________________________]

B. Sentence Appropriateness

☐ Sentence is disproportionate to the offense
☐ Sentence is greater than similarly situated cases
☐ Mitigating circumstances not fully considered at trial

Explanation:
[________________________________]
[________________________________]
[________________________________]

C. Matters in Extenuation and Mitigation

Military Service Record

Time in Service: [________________________________]

Deployments:

Location	Dates	Notes
[________________________________]	[________________________________]	[________________________________]
[________________________________]	[________________________________]	[________________________________]

Combat Service: ☐ Yes ☐ No
Details: [________________________________]

Awards and Decorations:
☐ [________________________________]
☐ [________________________________]
☐ [________________________________]

Performance Evaluations:
[________________________________]
[________________________________]

Prior Disciplinary Record:
☐ None prior to this offense
☐ Prior record: [________________________________]

Personal Circumstances

Family Situation:
[________________________________]
[________________________________]

Dependents Affected by Sentence:

Name	Relationship	Age	Impact
[________________________________]	[________________________________]	[____]	[________________________________]
[________________________________]	[________________________________]	[____]	[________________________________]

Financial Hardship:
[________________________________]
[________________________________]

Medical/Mental Health Conditions:
[________________________________]
[________________________________]

Circumstances of the Offense

☐ Isolated incident inconsistent with overall character
☐ Conduct influenced by PTSD/TBI/Mental Health condition
☐ Conduct influenced by substance abuse (now addressed)
☐ Other circumstances:
[________________________________]
[________________________________]

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SECTION VII: REHABILITATION EVIDENCE

A. Conduct Since Trial/During Confinement

☐ No disciplinary issues
☐ Exemplary conduct record
☐ Completion of rehabilitation programs:

Program	Date Completed	Certificate Attached
[________________________________]	[________________________________]	☐ Yes ☐ No
[________________________________]	[________________________________]	☐ Yes ☐ No
[________________________________]	[________________________________]	☐ Yes ☐ No

B. Educational Achievements

Course/Degree	Institution	Date
[________________________________]	[________________________________]	[________________________________]
[________________________________]	[________________________________]	[________________________________]

C. Work Record (if applicable)

[________________________________]
[________________________________]

D. Mental Health/Substance Abuse Treatment

☐ Currently in treatment
☐ Completed treatment program
☐ Provider: [________________________________]
☐ Progress: [________________________________]

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SECTION VIII: VICTIM IMPACT CONSIDERATION

(Complete if applicable)

☐ There was no individual victim
☐ Victim has been notified of this petition per victim rights requirements

Restitution Status:
☐ Full restitution paid
☐ Partial restitution paid: $[________]
☐ Restitution plan in place
☐ No restitution ordered

Victim's Position (if known):
[________________________________]
[________________________________]

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SECTION IX: POST-RELEASE PLAN

(For petitions seeking release from confinement or restoration to duty)

A. Residence Plan

Address: [________________________________]

Living With: [________________________________]

Relationship: [________________________________]

B. Employment Plan

Employer/Prospective Employer: [________________________________]

Position: [________________________________]

Start Date: [__/__/____]

Contact for Verification: [________________________________]

C. Support System

Name	Relationship	Contact
[________________________________]	[________________________________]	[________________________________]
[________________________________]	[________________________________]	[________________________________]

D. Continued Treatment Plan (if applicable)

[________________________________]
[________________________________]

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SECTION X: CHARACTER EVIDENCE

Letters of Support

Name	Relationship	Position/Rank	Attached
[________________________________]	[________________________________]	[________________________________]	☐ Exhibit [____]
[________________________________]	[________________________________]	[________________________________]	☐ Exhibit [____]
[________________________________]	[________________________________]	[________________________________]	☐ Exhibit [____]

Character Witness Statements

Name	Relationship	Summary of Statement
[________________________________]	[________________________________]	[________________________________]
[________________________________]	[________________________________]	[________________________________]

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SECTION XI: LEGAL ARGUMENT

A. Applicable Standards

The convening authority/clemency board has broad discretion to grant clemency based on any lawful consideration. Relevant factors include:
- Nature and circumstances of the offense
- Petitioner's personal characteristics (age, education, family status)
- Impact on victim
- Petitioner's rehabilitation potential
- Military service record
- Post-trial conduct

B. Argument for Clemency

[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]

C. Comparison to Similar Cases

[________________________________]
[________________________________]
[________________________________]

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SECTION XII: WAIVER OF AUTOMATIC FORFEITURES

(For petitions requesting waiver for dependent support under 10 U.S.C. § 858b)

☐ I request waiver of automatic forfeitures for the support of my dependents

Dependents:

Name	Relationship	Amount Requested
[________________________________]	[________________________________]	$[________]
[________________________________]	[________________________________]	$[________]

Allotment Information:
Current allotment to dependents: $[________]
Account for deposit: [________________________________]

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SECTION XIII: APPELLATE RIGHTS ACKNOWLEDGMENT

I understand that:

☐ Submitting this clemency petition does not waive my appellate rights
☐ I may still pursue appeals through the Court of Criminal Appeals and/or Court of Appeals for the Armed Forces
☐ The convening authority's/board's decision on clemency is separate from appellate review

Current Appellate Status:
☐ Appeal pending before [________________________________]
☐ No appeal filed
☐ Appellate rights waived

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SECTION XIV: CERTIFICATION

I, [________________________________], certify under penalty of perjury that the information contained in this petition is true and accurate to the best of my knowledge. I understand that providing false information may adversely affect my petition and could result in additional disciplinary action.

Petitioner Signature: [________________________________]

Date: [__/__/____]

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SECTION XV: COUNSEL CERTIFICATION

☐ This petition is submitted by counsel on behalf of the petitioner

I certify that I have reviewed this petition with my client and that the contents accurately reflect my client's clemency request.

Counsel Signature: [________________________________]

Printed Name: [________________________________]

Rank/Bar Number: [________________________________]

Contact Information: [________________________________]

Date: [__/__/____]

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EXHIBITS CHECKLIST

☐ Exhibit A: Character reference letters
☐ Exhibit B: Service record documents
☐ Exhibit C: Awards and decorations
☐ Exhibit D: Medical/mental health records
☐ Exhibit E: Rehabilitation program certificates
☐ Exhibit F: Employment verification
☐ Exhibit G: Educational certificates
☐ Exhibit H: Financial hardship documentation
☐ Exhibit I: Dependent support documentation
☐ Exhibit J: Other: [________________________________]

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SUBMISSION INSTRUCTIONS

Post-Trial Clemency (R.C.M. 1105):

Submit to the Staff Judge Advocate for the Convening Authority within 10 days of receipt of the certified record of trial.

Clemency and Parole Board:

Army: Office of the Judge Advocate General, Clemency and Parole Board, 2200 Army Pentagon, Washington, DC 20310-2200

Navy/Marine Corps: Navy Clemency and Parole Board, 720 Kennon Street SE, Suite 309, Washington Navy Yard, DC 20374-5023

Air Force: Secretary of the Air Force, Clemency and Parole Board, 1500 West Perimeter Road, Suite 3700, Joint Base Andrews, MD 20762

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SOURCES AND REFERENCES

• 10 U.S.C. § 860 - Article 60, UCMJ
• Manual for Courts-Martial, R.C.M. 1105-1107
• DoDI 1325.07 - Administration of Military Correctional Facilities
• DD Form 2703 - Post-Trial Information

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This template is provided for educational and informational purposes. Clemency petitions are time-sensitive and procedurally complex. Always consult with a qualified military defense attorney when preparing a clemency petition.