Illinois Administrative Code
Title 20 - CORRECTIONS, CRIMINAL JUSTICE, AND LAW ENFORCEMENT
Part 2000 - POLICY, HEARINGS AND FORMS
Appendix B - Form to File Claim of Torture
FORM TO FILE CLAIM OF TORTURE WITH TIRC
1. Name and current address of person claiming to have been tortured:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
2. Name and current address of person signing this form (if different than No. 1 above):
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
3. Details of claimant's felony conviction based upon allegedly tortured confession:
a. Circuit Court: ________________________________________________________
b. Year: ______________________________________________________________
c. Crimes of Conviction: _________________________________________________
d. Sentence: __________________________________________________________
e. Case Number (if known): _______________________________________________
4. Details of alleged torture:
a. Law enforcement agency: ______________________________________________
b. Dates: _____________________________________________________________
c. Names of persons committing alleged torture: _______________________________
____________________________________________________________________
____________________________________________________________________
d. Brief description of alleged torture: _______________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
5. As a result of the torture described above, did you confess to the offense of which you were convicted?YesNo
6. If you did confess, was that confession used against you to obtain the conviction?YesNo
7. Names and current addresses of persons who could support your claim:
a. __________________________________________________________________
b. __________________________________________________________________
c. __________________________________________________________________
d. __________________________________________________________________
e. __________________________________________________________________
8. Location of documentation supporting your claim: ____________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Claimant or Person Signing on Claimant's BehalfDate
