Middlesex CIU

Submitted By:

I am submitting this application on my own behalf
I am an attorney submitting this application on behalf of my client
I am a family member submitting this application on behalf of the defendant

Request for Review

Request to review a claim of factual innocence
Request for post-conviction forensic testing pursuant to M.G.L Â§278A
Request for BOTH post-conviction forensic testing pursuant to M.G.L Â§278A and a claim of factual innocence

Today's Date:

Defendant Name:

Defendant Name at Time of Trial (if applicable):

Pronouns:

she/her/hers
he/him/his
they/them/theirs
ze/hir/hirs
other

If other:

Race/Ethnicity:

Native American or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
Middle Eastern
Black or African American
White
Hispanic or Latinx
other

If other:

DOC#:

Defendant Date of Birth

Docket Number(s):

Co-Defendant (Yes/No):

Yes
No

Co-Defendant Name:

Applicant Name (if not defendant) and Relationship to Defendant:

Attorney for the Defendant:

Primary Language:

Highest Level of Education Achieved:

Applicant Address:

Applicant City:

Applicant Zip Code:

Applicant State:

Applicant Phone Number:

Applicant Email Address:

Date of Conviction

Total Sentence Length:

Incarceration Status:

Charge(s):

Trial Defense Attorney(s):

Trial Judge:

Trial or Plea:

Trial
Plea

Location of Incident:

Date of Incident:

Investigating Police Department(s):

What, if any, prior forensic testing occured through trial or post-conviction proceedings:

Are there additional suspects the defendant would like the CIU to consider:

Are there any new witnesses, alibis, etc.:

Has the defendant contacted an innocence organization? (If so, please list name and contact information):

Is the defendant in possession of copies of trial transcripts

Yes
No

Is the defendant currently incarcerated, paroled, on probation, or facing a restraint of liberty:

Yes
No

Is there currently a pending court proceeding related to this conviction:

Yes
No

Prior Appellate Filings:

Prior Post Conviction Filings:

Prior Habeas Corpus Filings

Describe the defendant's claim of innocence:

Describe what, if any, new evidence supports the claim of innocence:

Describe which, if any, contributing factors played a role in the defendant's conviction:

Additional Documents

I have been convicted of the offense noted above in Middlesex County.

agree

I understand that the CIU is part of the Middlesex District Attorney's Office, is not my attorney, and does not legally represent me.

agree

I am requesting that the CIU review my claim of factual innocence.

agree

I understand that the CIU may determine that my case does not meet their criteria and may deny my claim at any time.

agree

I understand that filing a CIU claim does not extend any post-trial petition deadlines.

agree

I acknowledge that providing false information will result in denial of my claim.

agree

I understand that this is an out-of-court process and there is no right of appeal relating to the denial of my claim by the CIU.

agree

I understand that any documents provided to the CIU will not be returned (we strongly encourage you to retain originals and submit copies only).

agree

I understand that the CIU determination does not prevent me from seeking future relief through standard processes.

agree

I understand that the CIU may request additional information from myself or counsel to facilitate their review of my claim.

agree

I understand that the CIU reserves the right to refuse disclosure of information that could potentially compromise the investigation of alternate suspects, endangers the life of a witness, or information that would be unlawful to release.

agree

I will not disclose any information derived from the CIU review without the express consent of the MDAO.

agree

Applicant Signature

Applicant Signature Date

Defendant Signature

Defendant Signature Date

Conviction Integrity Unit
Application For Review

Nature of Claim

Application Waiver

Conviction Integrity UnitApplication For Review

Nature of Claim

Application Waiver

Conviction Integrity Unit
Application For Review