TEXAS BOARD OF PARDONS AND PAROLESFULL PARDON APPLICATION FOR DEFERRED ADJUDICATION COMMUNITY SUPERVISION

DISCHARGE AND DISMISSAL,AND OTHER ARRESTS-NO CONVICTION ONLY

PLEASE NOTE: If the applicant has a conviction including a conviction which resulted in

community supervision, please do not use this application to request a pardon.

To qualify for a pardon based upon an orderfor deferred adjudication, the applicant:

1. Must successfully complete the term of deferred adjudication, and

2. Maysubmittheapplicationonorafterthe10thanniversarydateofsuccessfullycompleting the term of deferred adjudication.

CONSTITUTIONALAMENDMENT

(Amendment approved by the voters on November 8, 2011)

ArticleIV,TexasConstitution,ArticleIV,Section11(b)Inallcriminalcases,excepttreasonand impeachment,theGovernorshallhavepower,afterconvictionorsuccessfulcompletionofaterm ofdeferred adjudication community supervision, on the written signed recommendation and advice of the BoardofPardonsandParoles,oramajoritythereof,tograntreprievesand commutationsofpunishment andpardons; andundersuch rulesastheLegislaturemayprescribe,anduponthewritten recommendationandadviceofamajority oftheBoardofPardonsandParoles,heshallhavethepowerto remitfinesandforfeitures. TheGovernorshallhavethepowertograntonereprieveinanycapitalcase foraperiodnottoexceedthirty(30)days;andheshallhavepowerto revokeconditionalpardons. With the advice and consent of the Legislature, he may grant reprieves.

S.B.No.144

(Signed by the Governor on June 17, 2011)

AN ACT

relatingtoallowingapersonwhosuccessfullycompletesatermofdeferredadjudicationcommunity supervision to be eligible for a pardon.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Article 48.01, Code of Criminal Procedure, is amended to read as follows:

Art. 48.01. GOVERNOR MAY PARDON. (a) In all criminal cases, except treason and impeachment,theGovernorshallhavepower,afterconvictionorsuccessfulcompletionofaterm ofdeferred adjudication community supervision, on the written signed recommendation and advice of the Board of Pardons and Paroles, or a majority thereof, to grant reprieves and commutations of punishments and pardons; and upon the written recommendation and advice of a majority of the Board of Pardons and Paroles,heshallhavethepowertoremitfinesandforfeitures. TheGovernorshallhavethepowerto grantonereprieveinanycapitalcaseforaperiodnottoexceed30days;andheshallhavepowerto revokeconditionalpardons. WiththeadviceandconsentoftheLegislature, theGovernormaygrant reprieves, commutations of punishmentand pardons in cases of treason.

(b)TheBoardofPardonsandParolesmayrecommendthattheGovernor grant a pardon to aperson who:

(1) isplacedondeferredadjudicationcommunitysupervisionunderSection5,Article

42.12,andsubsequentlyreceivesa dischargeanddismissal under Section 5(c)of that article; and

(2) onorafterthe10thanniversaryofthedateofdischargeanddismissal,submitsawritten request to the board for a recommendation under thissubsection.

SECTION 2. ThisActtakeseffectJanuary1,2012,butonlyiftheconstitutionalamendment proposedbythe82ndLegislature,RegularSession,2011,authorizingthe governortograntapardontoa personwhosuccessfullycompletesatermofdeferredadjudicationcommunitysupervisionisapproved by the voters. If that amendment is not approved by the voters, this Act has no effect.

STEP 1:

INSTRUCTIONS

BEFORE YOU BEGIN, you must have the following documents to complete the application.

1.Offense reports for all arrests related to the deferred adjudication community supervision.

2.Certifiedcourtdocumentsforallarrest(s),e.g.,complaint,indictmentorinformation; orderfordeferredadjudication;orderofdismissal/discharge;and/orclerkstatement (fine/restitutionpaid).

3.Officialcriminalhistorystatementfromthesheriffofyourcountyofresidence.

4.Threelettersofrecommendationfrompersonsotherthanfamilymemberswhoare familiarwithyou. Lettersfromfamilymembersmaybesubmittedbutwillnotbe consideredasoneofthethreelettersofrecommendation.

************************************************************************ DONOTPROCEEDTOSTEP2UNTILYOUHAVEALLTHENECESSARY DOCUMENTSREQUIREDINSTEP1.

STEP 2:

Afteryouhaveobtainedallthedocuments, pleasereadtheapplicationinstructions carefully,andcompletetheapplicationformaccordingly. Toassistyouincompletingthe application, pleaseutilizetheFullPardonDeferredAdjudicationCommunity Supervision andArrest-NoConvictionApplicationChecklistonthefollowingtwopages. Checkthe appropriateboxasyoucompleteeachsection.

Donotalterthepresentationofthisapplicationeitherthroughreformattingorrewriting. Donotbindorstapletheapplicationwithanyothersubmittedmaterial.

Failuretoproperlycompletetheapplication willdelaytheprocessingofyourapplication. If we need additionalinformation,you may receive a phone call or letter from an employeeinouroffice.

STEP 3:

Pleasetypeorprintclearly,placeyournameatthetopofeachpage,andcompleteallitems.If necessary,youmayuse“N/A”(forNotApplicable),“Unknown,”“None,”or “DoNotRemember.” Aftercompleting allsections,pleasesignanddatetheapplication andmakeacopyforyourrecords.Mailthecompletedapplicationto:

TexasBoardofPardonsandParoles

ATTN:ClemencySection

8610ShoalCreekBlvd. Austin,TX78757

FULLPARDONDEFERREDADJUDICATIONCOMMUNITYSUPERVISIONANDOTHERARRESTS-NOCONVICTIONAPPLICATIONCHECKLIST

TheBoard’sClemencySectionhasprovidedthe checklistbelowtoassistyouinsubmittinga completedclemencyapplication. Thiswillallow forprocessingyourrequestinatimelymanner. If you need additional assistance in completing your application, pleaseviewourWebsiteat CreekBlvd.,Austin,Texas78757; Phone (512) 406-5852.

For your convenience, general information concerning clemency and procedures to obtain court documents and arrest/offense reports are includedat the end of this document (page 8).

SECTIONA: Demographic Information

Completeallfields,usingN/AorUnknownwherenecessary.BesuretoincludeallaliasnameslistedonyourDPScriminalhistory.

SECTIONB: Addresses

Listcurrentaddressandallpreviousaddressessinceage18.Use“DoNotRemember”ifnecessary.

SECTIONC: Employment

Listyourcurrentemploymentfirstandworkbackwards. Includeallavailableinformation.

SECTIOND: Justification

Part(1)StatewhyyouarerequestingaFullPardon.

Part(2)Statewhatyouhavedonesinceyousuccessfullycompletedyourdeferredadjudicationcommunitysupervisiontorehabilitateyourselfandbecomeaproductivememberofsociety.

SECTION E. Criminal History Information

Completeallfieldswiththeappropriateinformationfromyourcourtdocuments.

Ifmorethanonedeferredadjudicationcommunitysupervision,makeacopyofthispagetoaddadditionalinformation.

SECTIONF: Certification

Readthecertificationstatements. Signanddatetheapplicationinblackorblueink.

(CONTINUEDONNEXTPAGE)

CRIMINAL HISTORY DOCUMENTSREQUIREDFOR ALL ARRESTS

Offense Report(s)

Attachappropriatelawenforcementagencyoffensereportsforallarrestsrelatedtothedeferredadjudicationcommunitysupervisionandotherarrestsnotresultinginaconviction. Forexample,ifyouwerearrestedbytheAustinPoliceDepartment,youmustrequestoffensereportsfromthatagency.

Court Documents

Attach applicable certified court documentation foralladultarrestsrelatedtothedeferredadjudicationcommunitysupervisionandotherarrestsnotresultinginaconviction. Adultisdefinedasage16orolderorwhenyoungerthanage16,certifiedasanadult.

Complaint/IndictmentorInformation

OrderofDeferredAdjudication

OrderofDismissal//Discharge

NoBill

ClerkStatement(fine/restitutionpaid)

Seepage8forproceduresonhowtoobtaincertifiedcourtdocuments.

CriminalHistory

Attachanofficialcriminalhistorystatementfromthesheriffofyourcountyofresidence.ALLAPPLICANTS,includingnon-Texasresidents,mustprovideanofficialcriminalhistorystatementfromthesheriffoftheircountyofresidence.

ADDITIONAL INFORMATION IN SUPPORT OF THE APPLICANT’S REQUEST

Letters of Recommendation

Attachatleastthree(3)lettersofrecommendationfromcitizensdirectlyfamiliarwiththeapplicant(lettersfromfamilymemberswillonlybeacceptedassupplementalinformation.)Lettersofrecommendationmust:

beaddressedtotheBoardofPardonsandParoles(Example:“TotheBoardofPardonsandParoles:”--DonotaddressletterstoClemencySectionor“Towhomitmayconcern”);

containarecommendationforFullPardon(Example:“IrecommendafullpardononbehalfofAPPLICANT’SNAME.”);and

containthename,occupation,signature,telephonenumberandmailingaddressofthewriter.

NOTE: Ifanyagencywillnotprovidetherequesteddocumentation,youmust submitaletteraddressedtotheTexasBoardofPardonsandParoles. Your lettermustbedatedandreferencetheagencynamewiththeiraddressand phonenumber,thepersonwhomyoucontacted,thedate(s)thatyouattemptedto acquiretheinformation,andanexplanationastowhytheagencydidnotprovide therequestedmaterial.

FP-10-DA(12/29/2011)Date: ______Page 1 of 7

(LastName,FirstandMiddleName)

TEXAS BOARD OF PARDONS & PAROLES APPLICATIONFORA FULLPARDONFORDEFEREDADJUDICATIONCOMMUNITY SUPERVISIONDISCHARGEANDDISMISSAL,

ANDOTHERARRESTS-NOCONVICTION

TOTHEBOARDOFPARDONSANDPAROLESOFTEXAS:

I hereby request the Board of Pardons and Paroles or its designated agent to file this application for Clemency, to investigate the statementshereinmadeunderoathand,ifthefacts sojustify,make afavorablerecommendationtotheGovernoroftheState ofTexasthataFull Pardon be granted pursuant to the constitution and laws of the state of Texas.

A. DEMOGRAPHICINFORMATION(USE BLACK OR BLUE INK)

Currentfullname / LastName / Jr.III
Sr.IV / FirstName / FullMiddleName
Name(s)convictedunder
Race and sex / Race Sex
Date andplace of birth / Date of birth Place ofbirth
Driver’s license / State LicenseNumber
Aliasnames(includingmaiden name,namebyformermarriage andnicknames),birthdatesand anyotherformsofidentification
Current maritalstatus / Married – Spouse’sName:
Divorced / Separated / Single
Children/ support / alimony / I have childrenundertheageof18years.
Iamsupportingthe following namedchildren undertheage of 18 years:
I currently pay$/monthinchildsupport. I currently pay$/monthin alimony.

FP-10-DA(12/29/2011)Date: ______Page 2 of 7

(LastName,FirstandMiddleName)

B.ADDRESSES

CurrentMailingAddress
Indicateyourcurrentmailingaddress. / CurrentPhysicalAddress Provideinformationevenifthephysicaland mailingaddressesarethesame.
NumberandstreetApartment / NumberandstreetApartment
CityStateZipCode / CityStateZipCode
Homephonenumber [] Workphonenumber []
EmailAddress / Countyof residence
Years resided atphysical residence

PreviousAddresses

Listallpreviousphysicaladdressessinceage18. Donot use post office boxes.Ifyoulivedinanapartmentcomplex,list yourapartmentnumber.Alltimeperiodsmustbeaccountedfor. Include completedates(monthsandyearsofresidence), addresses, city, state and zip codes. Complete this pagebefore attaching any additional page(s). Place attachments behind this page.

From(month/year): / Numberandstreet / Apartment
To(month/year): / City / State / ZipCode
From(month/year): / Numberandstreet / Apartment
To(month/year): / City / State / ZipCode
From(month/year): / Numberandstreet / Apartment
To(month/year): / City / State / ZipCode
From(month/year): / Numberandstreet / Apartment
To(month/year): / City / State / ZipCode

FP-10-DA(12/29/2011)Date: ______Page 3 of 7

(LastName,FirstandMiddleName)

C. EMPLOYMENT

Pleasegivea comprehensiveadult(sinceage18)employmenthistory,beginningwithyourpresentemploymentand workingbackwards. Include employer’s name,address, and yourjobpositionworkingtitle, description ofjobduties,salary, datesemployed,andreason forleaving. Completethis pagebeforeattaching anyadditionalpage(s).Placeattachments behind thispage.

From(month/year): / Employername
To(month/year): / Employeraddress
Jobposition(workingtitle) / Descriptionofyourworkduties
Average monthlysalary / Reasonforleaving
From(month/year): / Employername
To(month/year): / Employeraddress
Jobposition(workingtitle) / Descriptionofyourworkduties
Average monthlysalary / Reasonforleaving
From(month/year): / Employername
To(month/year): / Employeraddress
Jobposition(workingtitle) / Descriptionofyourworkduties
Average monthlysalary / Reasonforleaving
From(month/year): / Employername
To(month/year): / Employeraddress
Jobposition(workingtitle) / Descriptionofyourworkduties
Average monthlysalary / Reasonforleaving

FP-10-DA(12/29/2011)Date: ______Page 4 of 7

(LastName,FirstandMiddleName)

D.JUSTIFICATIONFORCLEMENCYCONSIDERATION

(1)State the reasons and circumstances for requesting a full pardon.

Complete thispagebefore attaching any additionalpage(s).Place anyattachmentsimmediatelybehindthispage.

(2)Whathaveyoudonesinceyousuccessfullycompletedyourdeferredadjudication community supervision to show that you deserve full pardon consideration, including rehabilitative efforts that you have made?

Complete this pagebefore attaching any additional page(s). Place any attachments immediately behindthis page.

FP-10-DA(12/29/2011)Date: ______Page 5 of 7

(LastName,FirstandMiddleName)

E. CRIMINALHISTORYINFORMATION

Provideinformationonalladultcriminaloffenses (list one offense per page)andthedispositionof eacharrest. Forthesepurposes,adultisdefinedas allarrestsrelatedtothedeferredadjudication communitysupervisionandotherarrestsnotresultinginaconvictioncommittedwhenage16or olderorwhenyoungerthanage16butcertifiedasanadult. All blanks must be completed for each criminaloffense. Photocopy as many of this blank page and the applicant’s version blank page as needed to list additional offenses.

Criminal Offense:

County: State:

CauseNumber:

CourtofAdjudication:

Dateof Order ofDeferred

Adjudication:

Date ofsentencingorother formof court adjudication. Mark “N/A” ifnot adjudicatedin a Court.

Court Imposed Community

Supervision/Disposition:

Example:2 yearsdeferred adjudication probation; Chargeddismissed;Releasewithout prosecution; No formal charge; No bill.

Fineordered?YesNoIf“Yes”,indicatetheamount:$

Wasthefine paidinfull?YesNo

Restitution ordered?YesNoIf“Yes”,indicatetheamount:$

Wastherestitutionpaidinfull?YesNo

Dismissal/DischargeDateand

Disposition:

Examplesofpossibledisposition: Successfullydischargeddeferred adjudication communitysupervision;unsuccessfullydeferred adjudication community supervision; Discharged deferred adjudication communitysupervision; Chargeddismissed; Releasewithout prosecution; No formal charge; No bill.

FP-10-DA(12/29/2011)Date: ______Page 6 of 7

(LastName,FirstandMiddleName)

APPLICANT’SVERSION

On this “Applicant’s Version” page you are providing additional information – your version of events

–abouttheoffensethatyoulistedonthepreceding“CriminalHistoryInformation”page. Describe in your own words the factual circumstances of the offense.

Responsessuchas“N/A,”“Unknown,”or“None”arenotacceptablefor thissectionofthe application.Ifyoudo notrememberanyofthedetailsaboutthisoffenseyoumayprovideastatement to that effect.

CriminalOffense:

Listtheoffenseas itappearsinthecourtdocumentation.TheoffenseshouldmatchthewordingonthecorrespondingCriminalHistoryInformationpage.

Location:

Offensedate(s):

Law enforcementagencyinvolved:

State in detailevents leading upto theoffense andtheextent ofyour involvement inthis case:

Complete thispagebefore attaching any additionalpage(s).Place anyattachmentsimmediatelybehindthispage.

CourtDocumentationOffenseReports

Placeallcourtdocumentsandoffense/arrestreportsforthisoffenseafteryourSubject’sVersionpage(s). Referto

Procedures for Obtaining Court Documentation on page8.

FP-10-DA(12/29/2011)Date: ______Page 7 of 7

(LastName,FirstandMiddleName)

F.CERTIFICATIONBYAPPLICANT

Pleasereadthefollowingstatementscarefullyandindicateyourunderstanding andacceptanceby signinginthespaceprovided.Thisapplicationmustbesigned.

Iherebygivemypermission totheBoardofPardonsandParolesoritsdesignated agenttomakeany inquiryandreceiveanyinformationofrecordthatitmaydeemproperintheinvestigationofthis applicationforclemency;and

IunderstandthatcompliancewiththeserequirementsissufficientfortheBoard'sconsiderationofthis application,butcompliancedoesnotnecessarilymeanthatfavorableactionwillresult.

IherebyswearuponmyoaththatIamthesubjecthereinnamedandthefactscontained inthis applicationaretrueandcorrect.

Applicant’s Signature (Full Name)

Date

PROCEDURES FOR OBTAINING COURT DOCUMENTATION

AllcourtdocumentsmustbeCERTIFIED,whethertheyoriginatefromtheofficeoftheDistrict,County,or

MunicipalClerk.Acquiretheproperdocumentation,accordingly:

IFconvictedandthejudgmentincludedacourtorderedfineandorrestitution, furnishastatementfromthe appropriateclerkconfirmingtheamountpaid.

IFconvictedandthesentenceisprobatedordeferred,furnishtheComplaint/Indictment orInformation, Judgment,SentenceandDismissal.

PROCEDURES FOR OBTAINING ARREST/OFFENSEREPORTS

Foreachcriminaloffense,acquirefromtheappropriate lawenforcement arrestingagencycopiesofthe arrest/offense reports.Thesecopiesofreportsdonothavetobecertified.Foroffensesinvolvingdrugs,please providecopiesoflaboratoryreports.

GENERALINFORMATION

Definition-AnunconditionalactofexecutiveclemencybytheGovernorwhichservestoreleasethegrantee fromtheconditionsofhisorhersentenceandfromanydisabilitiesimposedbylawthereby.

AFullPardonrestoresthefollowingcivilrights:

1. Righttovote.

2. Righttoholdpublicoffice.

3. Righttoserveonajury.

4. Licensingprivilegesforcertaintypesofemployment(however,youmustcheckwiththeappropriate licensingauthoritytodetermineifafullpardonisnecessarytobelicensed). Ifavailable,pleaseprovide writtendocumentationfromthatauthorityadvisingthatyouwillnotbeconsideredforalicensewithout receivingafullpardon. Ifthelicensingauthoritywillnotprovideyouwithwrittendocumentation, please obtainandfurnishthe nameof thelicensingauthority,phonenumber,and nameof thepersonyou contacted.

5. RighttoserveasExecutororAdministratorofanestate.

AFULLPARDONRESTORESVOTINGRIGHTS. Pleasenote,effectiveSeptember01,1997,afelon’s votingrightsareautomatically restoredwhenonefullydischargesthefelonysentence,includinganytermof incarceration,parole,orsupervision,orcompletedaperiodofprobationorderedby anycourt.

AFULLPARDONDOESNOTexpungeanarrestunderthe criminallaws. Thiscan onlybeaccomplishedby petitioningadistrictcourtinthecountyofconviction.

AFULLPARDON DOESNOTrestoretherightoftheapplicanttodriveandoperateamotorvehicleupon publichighwaysafteranautomaticsuspensionofthatlicenseasaresultofaconvictionforDrivingWhile Intoxicatedorothersimilarsuspension,unlesstheGovernor'sProclamationspecificallysostates.

Foryourrecords,pleaseretaincopiesofalldocumentation,includingtheapplicationthatyousubmitto theClemencySection.

WeareadvisingyouNOTtoprovideoriginalsofpersonalitems,including butnotexclusive tophotos, transcripts,birthandothercertificates,achievement awards,licenses,literatureandotheridentification cardsoritems,notebooks orbinders,andclemencyproclamations. Youmayinlieuoforiginalsprovide copiesofthesedocumentswithyoursubmittedapplication.

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