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Motion For Compassionate Release From AO Fillable
Motion For Compassionate Release From AO Fillable
FOR THE
__________ DISTRICT OF __________
NOTICE
The public can access electronic court files. Federal Rule of Criminal Procedure 49.1
addresses the privacy and security concerns resulting from public access to electronic court
files. Under this rule, papers filed with the court should not contain: an individual’s full social
security number or full birth date; the full name of a person known to be a minor; or a
complete financial account number. A filing may include only: the last four digits of a social
security number; the year of an individual’s birth; a minor’s initials; and the last four digits of
a financial account number.
Does this motion include a request that any documents attached to this motion be filed
under seal? (Documents filed under seal are not available to the public.)
☐ Yes
☐ No
If you answered yes, please list the documents in section IV of this form.
Page 1 of 6
I. SENTENCE INFORMATION
Date of sentencing:
☐ Yes
☐ No
☐ Yes
☐ No
18 U.S.C. § 3582(c)(1)(A) allows you to file this motion (1) after you have fully exhausted all
administrative rights to appeal a failure of the Bureau of Prisons to bring a motion on your
behalf, or (2) 30 days after the warden of your facility received your request that the warden
make a motion on your behalf, whichever is earlier.
Please include copies of any written correspondence to and from the Bureau of Prisons related
to your motion, including your written request to the Warden and records of any denial from
the Bureau of Prisons.
1
The requirements for this compassionate release motion being filed with the court differ from
the requirements that you would use to submit a compassionate release request to the Bureau
of Prisons. This form should only be used for a compassionate release motion made to the
court. If you are submitting a compassionate release request to the Bureau of Prisons, please
review and follow the Bureau of Prisons program statement.
Page 2 of 6
Have you personally submitted your request for compassionate release to the Warden
of the institution where you are incarcerated?
☐ No, I did not submit a request for compassionate release to the warden.
Please use the checkboxes below to state the grounds for your request for compassionate
release. Please select all grounds that apply to you. You may attach additional sheets if
necessary to further describe the reasons supporting your motion. You may also attach any
relevant exhibits. Exhibits may include medical records if your request is based on a medical
condition, or a statement from a family member or sponsor.
☐ Yes.
☐ No.
If you answered no, go to Section B below. You do not need to fill out Section A.
If you answered yes, you may be eligible for release under 18 U.S.C. § 3582(c)(1)(A)(ii) if you
meet two additional criteria. Please answer the following questions so the Court can determine
if you are eligible for release under this section of the statute.
Page 3 of 6
Have you served 30 years or more of imprisonment pursuant to a sentence imposed
under 18 U.S.C. § 3559(c) for the offense or offenses for which you are imprisoned?
☐ Yes.
☐ No.
Has the Director of the Bureau of Prisons determined that you are not a danger to the
safety of any other person or the community?
☐ Yes.
☐ No.
B. Do you believe there are other extraordinary and compelling reasons for your
release?
☐ Yes.
☐ No.
If you answered “Yes,” please check all boxes that apply so the Court can determine whether
you are eligible for release under 18 U.S.C. § 3582(c)(1)(A)(i).
Page 4 of 6
Please explain below the basis for your request. If there is additional information regarding any
of these issues that you would like the Court to consider but which is confidential, you may
include that information on a separate page, attach the page to this motion, and, in section IV
below, request that that attachment be sealed.
Please list any documents you are attaching to this motion. A proposed release plan is included
as an attachment. You are encouraged but not required to complete the proposed release plan.
A cover page for the submission of medical records and additional medical information is also
included as an attachment to this motion. Again, you are not required to provide medical
records and additional medical information. For each document you are attaching to this
motion, state whether you request that it be filed under seal because it includes confidential
information.
☐ Yes ☐ Yes ☐ No
☐ Yes ☐ Yes ☐ No
Page 5 of 6
V. REQUEST FOR APPOINTMENT OF COUNSEL
☐ Yes
☐ No
For the reasons stated in this motion, I move the court for a reduction in sentence
(compassionate release) under 18 U.S.C. § 3582(c)(1)(A). I declare under penalty of
perjury that the facts stated in this motion are true and correct.
Date Signature
Name
Institution’s Address
Page 6 of 6
ATTACHMENT TO MOTION FOR COMPASSIONATE RELEASE
NOTICE
The public can access electronic court files. Federal Rule of Criminal Procedure 49.1 addresses
the privacy and security concerns resulting from public access to electronic court files. Under
this rule, papers filed with the court should not contain: an individual’s full social security
number or full birth date; the full name of a person known to be a minor; or a complete
financial account number. A filing may include only: the last four digits of a social security
number; the year of an individual’s birth; a minor’s initials; and the last four digits of a
financial account number.
If you provide information in this document that you believe should not be publicly
available, you may request permission from the court to file the document under seal. If
the request is granted, the document will be placed in the electronic court files but will
not be available to the public.
☐ Yes
☐ No
ATTACHMENT TO MOTION FOR COMPASSIONATE RELEASE
Provide the full address where you intend to reside if you are released from prison:
Provide the name and phone number of the property owner or renter of the address
where you will reside if you are released from prison:
Provide the names (if under the age of 18, please use their initials only), ages, and
relationship to you of any other residents living at the above listed address:
If you have employment secured, provide the name and address of your employer and
describe your job duties:
B. Medical needs
Will you require ongoing medical care if you are released from prison?
☐ Yes
☐ No
☐ Yes
☐ No
If yes, provide the name of your insurance company and the last four digits of the
policy number. If no, how do you plan to pay for your medical care?
If no, are you willing to apply for government medical services (Medicaid/Medicare)?
☐ Yes
☐ No
Do you have copies of your medical records documenting the condition(s) for which
you are seeking release?
☐ Yes
☐ No
If yes, please include them with your motion. If no, where are the records located?
ATTACHMENT TO MOTION FOR COMPASSIONATE RELEASE
Are you currently prescribed medication in the facility where you are incarcerated?
☐ Yes
☐ No
Do you require durable medical equipment (e.g., wheelchair, walker, oxygen, prosthetic
limbs, hospital bed)?
☐ Yes
☐ No
☐ Yes
☐ No
If yes, please list the required assistance and how it will be provided:
☐ Yes
☐ No
ATTACHMENT TO MOTION FOR COMPASSIONATE RELEASE
If yes, please provide address of the anticipated home or facility and the source of
funding to pay for it.
Are the people you are proposing to reside with aware of your medical needs?
☐ Yes
☐ No
Do you have other community support that can assist with your medical needs?
☐ Yes
☐ No
Provide their names, ages, and relationship to you. If the person is under the age of 18,
please use their initials only:
☐ Yes
☐ No
SIGNATURE
I declare under penalty of perjury that the facts stated in this attachment are true and
correct.
Date Signature
Name
Institution’s Address
ATTACHMENT TO MOTION FOR COMPASSIONATE RELEASE
NOTICE
The public can access electronic court files. Federal Rule of Criminal Procedure 49.1 addresses
the privacy and security concerns resulting from public access to electronic court files. Under
this rule, papers filed with the court should not contain: an individual’s full social security
number or full birth date; the full name of a person known to be a minor; or a complete
financial account number. A filing may include only: the last four digits of a social security
number; the year of an individual’s birth; a minor’s initials; and the last four digits of a
financial account number.
If you attach documents to this form that you believe should not be publicly available,
you may request permission from the court to file those documents under seal. If the
request is granted, the documents will be placed in the electronic court files but will not
be available to the public.
Do you request that the attachments to this document be filed under seal?
☐ Yes
☐ No
ATTACHMENT TO MOTION FOR COMPASSIONATE RELEASE
SIGNATURE
I declare under penalty of perjury that the facts stated in this attachment are true and
correct.
Date Signature
Name
Institution’s Address