IMPORTANT NOTICE
To Applicants for Certificate of Pardon

The following notice is provided pursuant to the Privacy Act of 1974 to help you to understand what is involved in requesting a certificate evidencing your pardon under the President Carter's Proclamation of January 21, 1977, and why we need to obtain certain information about you.

     The information that we request from you on the accompanying application form is needed to enable the Attorney General to determine whether you were pardoned by President Carter's Proclamation of January 21, 1977, and, therefore, are eligible to receive a Certificate of Pardon. This is our only purpose in asking you to complete and sign the application. The failure to provide your Social Security number will not prejudice your application for a Certificate of Pardon. However, providing your Social Security number may assist us in processing your application and may assist law enforcement agencies in updating their records to reflect the fact that a pardon was granted.

     Our authority for requesting the information solicited in the accompanying application is the United States Constitution, Article II, Section 2 (the pardon clause); Presidential Proclamation 4483, dated January 21, 1977; and Order of the Attorney General No. 1012-83, 48 Fed. Reg. 22290 (1983), as codified in 28 C.F.R. §§ 0.35 and 0.36 (the authority of the Office of the Pardon Attorney).

     Upon specific request, we advise anyone who asks whether a named person has been granted or denied clemency. In addition, the pendency of an application is confirmed to anyone who asks, unless extraordinary considerations of privacy are presented in a particular case that outweigh the public interest in having access to this information. If you believe such privacy considerations are present in your case, you should so inform us in writing when you submit the application.

     A record of each Certificate of Pardon will be maintained in the Office of the Pardon Attorney as an official record, together with your application form and any other documents compiled in the course of processing your request. The Pardon Attorney may disclose the contents of such files to anyone when the disclosure is required by law or the ends of justice. In particular, public record documents that may be compiled in the course of processing an application, such as the judgment order from the criminal case for which pardon is sought, trial or sentencing transcripts, court opinions, and newspaper articles, are generally made available upon request by third-parties (including representatives of the news media) pursuant to the Freedom of Information Act, unless such disclosure could reasonably be expected to constitute an unwarranted invasion of the petitioner's personal privacy. In addition, unsolicited Congressional correspondence is treated in the same manner. On the other hand, non-public documents that may be compiled in the course of processing an application, such as the application form itself, are not generally available under the Freedom of Information Act.

Application Form - You must have Adobe Acrobat version 7 or higher to view this form. Download free Adobe Acrobat Reader.
Presidential Proclamation (4433) and Executive Order (11967)