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Covers the type of clemency requested, including expedited review options and sentence-related commutations, plus prior clemency history. Collects applicant identity and contact details, aliases, institutional information, and representation details. Requests conviction specifics for each case, including offense dates, sentence information, OTN numbers, and an incident narrative describing involvement and how the applicant was caught, with supplemental-page options and official-use fields.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/pennsylvania-board-of-pardons-application-for-clemency/281693/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/pennsylvania-board-of-pardons-application-for-clemency/281693.png","ImageObject",442,249,{"name":88,"@type":89},"River Wang","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-30","2026-09-16",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",10,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What clemency types can be requested on this form?","Question",{"text":109,"@type":110},"The form lists multiple options, including commute parole, expedited review, and sentence commutations such as life imprisonment to life on parole or death sentence to life imprisonment, along with minimum/maximum sentence changes tied to certain convictions.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What information is required about the applicant?",{"text":114,"@type":110},"Applicant details include name, aliases, date of birth, social security number, address, contact phones and email, institutional or inmate/parole numbers if applicable, and representation type (self, friend/family, attorney, or department of corrections for confined applicants).",{"name":116,"@type":107,"acceptedAnswer":117},"How should convictions be provided for clemency consideration?",{"text":118,"@type":110},"Convictions must be entered case by case with offense dates, the named offenses, sentence information, grade/sealed status, OTN numbers, and a narrative describing the incident, involvement, where the applicant was, what was done, and how the applicant was caught. Supplemental pages for Section 3 may be attached.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},281693,1790024367,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":136,"language":137,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":138,"faqs":139,"seo_title":140,"seo_description":61,"update_tm":141,"read_time":101,"preview_page_count":4},1099514067438,"https://ap-avatar.wpscdn.com/avatar/100002539ee87300030?x-image-process=image/resize,m_fixed,w_180,h_180&k=1780474512215547542","# Pennsylvania Board of PardonsApplication for Clemency\n\n\n| Official Use Only.Do not complete this Section.   |  |  |\n| --- | --- | --- |\n| Application Number:   | Board of Pardons Number:   | Session Date:   |\n\n\n| Section 1:Type of Clemency Requested   |\n| --- |\n| □ Commute Parole  \u003Cbr>回Pardon  \u003Cbr>□Expedited Review for:  \u003Cbr>□ Commute Life Imprisonment to Life on Parole  \u003Cbr>□ Commute Minimum Sentence  \u003Cbr>Non-Violent Marijuana  \u003Cbr>□ Commute Death Sentence to Life Imprisonment  \u003Cbr>□ Commute Maximum Sentence  \u003Cbr>and/or Paraphernalia Conviction(s)   |\n| Have you previously filed a clemency application in Pennsylvania?□Yes □No  \u003Cbr>If yes:Date Granted or Denied(if applicable and known):   |\n\n\n| Section 2:Applicant Information   |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- |\n| 口Miss口Ms.  \u003Cbr>口Mrs.■ Mr.  \u003Cbr>□ Other:   | First Name:  \u003Cbr>John   |  | Full Middle Name (if applicable):  \u003Cbr>N/A   |  | Last Name:  \u003Cbr>Smith   |  | Suffix  \u003Cbr>(if applicable):  \u003Cbr>N/A   |\n| Aliases and Other Names:State other names by which you have been known.  \u003Cbr>Include maiden names,names by a former marriage,and aliases.  \u003Cbr>Johnny,Jay Smith,John Smith-Jones   |  |  |  |  | Date of Birth:  \u003Cbr>01/14/1972   | Social Security Number:  \u003Cbr>599-20-1234   |  |\n| Address(Number and Street):  \u003Cbr>3201 Kensington Ave.   |  |  |  |  | Apartment Number/Floor(if applicable):  \u003Cbr>4A   |  |  |\n| City:  \u003Cbr>Philadelphia   |  | State:  \u003Cbr>PA   |  |  | Zip Code:  \u003Cbr>19134   |  |  |\n| Email Address(if applicable):  \u003Cbr>John.Smith@email.com   |  | Primary Phone Number (if applicable):  \u003Cbr>215-555-5555   |  |  | Secondary Phone Number (if applicable):  \u003Cbr>215-555-6556   |  |  |\n| Name of Institution (if currently confined):  \u003Cbr>N/A   |  | Inmate Number(if applicable):  \u003Cbr>N/A   |  |  | Parole Number(if applicable):  \u003Cbr>N/A   |  |  |\n| Representation:  \u003Cbr>□ Self (Proceed to Section 3)  \u003Cbr>□Friend  \u003Cbr>□ Family Member  \u003Cbr>□Attorney  \u003Cbr>□ Department of Corrections(Confined Applicants Only)  \u003Cbr>Note:All confined applicants must have  \u003Cbr>representation as they cannot represent themselves  \u003Cbr>if granted a public hearing.   |  |  |  | Representative Information   |  |  |  |\n|  |  |  |  | Name:   | Philadelphia Lawyers for Social Equity   |  |  |\n|  |  |  |  | Address   | 230 S.Broad St.   |  |  |\n|  |  |  |  |  | Suite 1102   |  |  |\n|  |  |  |  |  | Philadelphia,PA   |  |  |\n|  |  |  |  |  | 19102   |  |  |\n|  |  |  |  | Phone Number   | 267-519-5323   |  |  |\n|  |  |  |  | Email Address   | info@plsephilly.org   |  |  |\n\n\n| Section 3:Convictions For Which Clemency Is Requested   |  |  |  |  |\n| --- | --- | --- | --- | --- |\n| Case \\#1(Oldest Case)   |  |  |  |  |\n| Offense Date:  \u003Cbr>04,18,2006   | Offense(s)-List each conviction by name,not  \u003Cbr>crimes code.Do not include non-convictions.   | Official Use Only.Do not complete this Section.   |  |  |\n|  |  | Sentence(s):   | Grade/Sealed   |  |\n|  | Manuf/Del/Poss/W Int Manuf Or Del  \u003Cbr>1._   |  |  |  |\n|  |  |  |  |  |\n|  | 3._______   |  |  |  |\n|  | 4._______   |  |  |  |\n|  |  |  |  |  |\n| OTN Number:  \u003Cbr>N400000 -1   | 5.______  \u003Cbr>6._______   |  |  |  |\n|  | 7.______   |  |  |  |\n|  | 8.___   |  |  |  |\n|  | 9._______   |  |  |  |\n|  | 10._______   |  |  |  |\n|  |  |  |  |  |\n| Describe the incident and how you were involved.Where were you,what did you do,and how were you caught?   |  |  |  |  |\n|  was selling drugs on the_street to support my habit and to try and earn enough money to get my  \u003Cbr>self out of homelessness.I was subsequently caught committing the crime in the city of Philadel  \u003Cbr>phia on 04/18/2006.I am sorry that I do not remember more about this arrest.I was addicted to  \u003Cbr>drugs and alcohol at the time and was doing a lot of selling to support my habit,and it was 17  \u003Cbr>years ago,too.   |  |  |  |  |\n\n□ Check this box if you are attaching a Section 3 supplemental page.  \n\n| Official Use Only.Do not complete this Section.   |  |\n| --- | --- |\n|  ","cbCaivW4P5FRpFjf","https://ap.wps.com/l/cbCaivW4P5FRpFjf","pdf",7673478,29,"English","# Section 1: Type of Clemency Requested\n# Section 2: Applicant Information\n# Section 3: Convictions For Which Clemency Is Requested","[{\"question\":\"What clemency types can be requested on this form?\",\"answer\":\"The form lists multiple options, including commute parole, expedited review, and sentence commutations such as life imprisonment to life on parole or death sentence to life imprisonment, along with minimum/maximum sentence changes tied to certain convictions.\"},{\"question\":\"What information is required about the applicant?\",\"answer\":\"Applicant details include name, aliases, date of birth, social security number, address, contact phones and email, institutional or inmate/parole numbers if applicable, and representation type (self, friend/family, attorney, or department of corrections for confined applicants).\"},{\"question\":\"How should convictions be provided for clemency consideration?\",\"answer\":\"Convictions must be entered case by case with offense dates, the named offenses, sentence information, grade/sealed status, OTN numbers, and a narrative describing the incident, involvement, where the applicant was, what was done, and how the applicant was caught. Supplemental pages for Section 3 may be attached.\"}]","Pennsylvania Board of Pardons - Application for Clemency | PDF",1789567521]