26.07.090 Pardon Application Form

$50 non-refundable application/processing fee

Notice: This form must be completed by all pardon applicants.

Applications must be typewritten or clearly printed. All questions must be answered if applicable. If not, indicate by N/A (not applicable). If space provided is not sufficient for complete answers, or if you wish to furnish additional information, attach sheets and number answers to correspond with questions. This document must be notarized.

(a) Full Name: __

(b) Address:

(c) Telephone #: __

(d) Social Security #:

(e) Date of Birth:

(f) Place of Birth:

(g) Male/Female:

(h) Marital Status:

(i) No. of children: Ages:

(j) What is the crime, date of conviction and sentence of the crime for which you are requesting a pardon?_________________

(k) Please describe the circumstances of each offense and conviction for which a pardon is sought (attach a separate sheet if more space is needed):____

(l) Have you requested a pardon before? If yes, when? __

(m) Why are you requesting this pardon: Employment Entry into service other (explain) __

(n) Please briefly describe the reasons for this pardon request. A lengthier explanation with supporting documentation may be attached:___

EDUCATION AND TRAINING

(o) Highest Grade Completed: __

(p) Name of School: ___

MILITARY SERVICE

(q) Branch of Service: ___

(r) Service No. Type of discharge: ___

(s) Dates of active duty: ___________to ___________

(t) Present place of employment: ___

(u) Address and telephone number: ___

(v) How long? ___

(w) Kind of work ___

(x) Previous employment and dates: ___

(y) Have you ever been convicted of an offense (include motor vehicle violations) within tribal jurisdiction since the conviction for which you are requesting a pardon? Yes __No __

(z) If the answer to question 25 is yes, please provide details (attach a separate sheet if more space is needed.)

(aa) Have you ever been arrested by federal authorities or by any other tribal authority other than Turtle Mountain authorities? Yes_ No __

(bb) If answer to question 27 is yes, please list each arrest giving the date and disposition of the case (attach a separate sheet if necessary

(cc) Do you have a specific and compelling need for a pardon? Yes

(dd) What is the need? (be specific)___

(ee) Applicants must demonstrate a substantial period of good citizenship and an exemplary life since conviction. Please indicate examples of constructive conduct and specific achievements if any (attach a separate sheet if more space is needed):___

(ff) How will a pardon substantially aid you in improving your life (attach a separate sheet if more space is needed)

(gg) How will a pardon benefit society?___

__

REFERENCES:

(hh) Please provide three (3) letters of reference from persons other than you or members of your family, attesting to your good character and reputation. Please list the names of individuals below:

Name/Relationship Address Phone No.

1.___

2.____

3.____

Upon granting of a pardon, it is the recipients responsibility to provide this information to Tribal Court and Law Enforcement for processing of expungement.

By virtue of request for pardon, applicant may be subject to the following: Drug testing and ongoing follow-up or future assessments.

I hereby authorize release of my criminal records to the Chairman or the Chairman's representative.

________________

Pardon applicant

Notice: By submitting this application, you are consenting to public release of your name should a pardon be issued by the Chairman.

Subscribed and Sworn to before me this day of , 20__

Notary Public in and for the State of

My commission expires:_____