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Fill in Your Mississippi Clemency Template

The Mississippi Clemency Form is an official application that individuals can submit to request clemency from the Governor's office. This form serves as a means for applicants to seek a pardon, commutation of sentence, or restoration of civil rights. It is essential to understand that submitting this application does not guarantee that the clemency request will be granted.

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Fill in Your Mississippi Clemency Template

Content Overview

The Mississippi Clemency form serves as a crucial document for individuals seeking relief from the consequences of past criminal convictions. This application, which must be meticulously filled out by the applicant, includes various sections that gather essential personal information, such as name, date of birth, and social security number, alongside a detailed account of criminal charges and convictions. It prompts applicants to disclose their marital status, dependent children, and employment history, thus providing a comprehensive view of their current circumstances. The form offers three distinct types of clemency requests: a pardon, a commutation of sentence, or restoration of civil rights. Additionally, it requires applicants to list any disciplinary actions received during incarceration and to provide references who can vouch for their character. A critical aspect of the application is the requirement for a separate letter detailing the extenuating circumstances that support the clemency request, accompanied by letters of recommendation from various sources. This thorough process underscores that submitting the form does not guarantee clemency; rather, it opens the door for consideration by the Governor's office. Applicants must remain vigilant in keeping their contact information updated and must return the completed form to the designated address for review.

Mississippi Clemency Preview

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	State	Zip

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)__________________________________________________________________________________

Charge	Conviction Received
____________________________	___________________________________
Date Convicted	County of Court
____________________________	___________________________________
Judge	Prosecutor
____________________________	___________________________________
Defense Attorney	Sentence
____________________________	___________________________________
Period of Incarceration	Place Incarcerated

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)__________________________________		_________________________________________
Employer's Name		Employer’s Address
_______________________	___________________
______________________________
Supervisor	Period Employed	Reason for Leaving

3)__________________________________		_________________________________________
Employer's Name		Employer’s Address
_______________________	___________________
______________________________
Supervisor	Period Employed	Reason for Leaving

4)__________________________________		_________________________________________
Employer's Name		Employer’s Address
_______________________	___________________
______________________________
Supervisor	Period Employed	Reason for Leaving

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

Get Mississippi Clemency File

File Features

Fact Name	Description
Application Requirement	The applicant must fully complete the application for clemency, using additional paper if necessary.
Types of Clemency	The application allows for requests for a pardon, commutation of sentence, or restoration of civil rights.
Governing Law	The clemency process in Mississippi is governed by Mississippi Code Annotated § 47-7-17.
Consideration Disclaimer	Submitting the application does not guarantee that the clemency request will be granted.
Supporting Documents	Applicants must include a separate letter detailing extenuating circumstances along with letters of recommendation.
Contact Information	Applicants need to provide emergency contact information for follow-up, if necessary.
Disciplinary History	Applicants must disclose any disciplinary actions received while incarcerated, detailing each instance.

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