Every application for relief by the Pardon Board shall be in writing, addressed to the Board of Pardons, signed under oath by the convict or someone in the convict's behalf, shall state concisely the grounds upon which the relief is sought, and in addition shall contain the following facts:
(1) the name under which the convict was indicted, and every alias by which the convict is or was known;
(2) the date and terms of sentence, and the names of the offense for which it was imposed;
(3) the name of the trial judge and the county attorney who participated in the trial of the convict, together with that of the county of trial;
(4) a succinct statement of the evidence adduced at the trial, with the endorsement of the judge or county attorney who tried the case that the statement is substantially correct. If this statement and endorsement are not furnished, the reason for failing to furnish them shall be stated;
(5) the age, birthplace, and occupation and residence of the convict during five years immediately preceding conviction;
(6) a statement of other arrests, indictments, and convictions, if any, of the convict.
Every application for relief by the pardon board shall contain a statement by the applicant consenting to the disclosure to the board of any private data concerning the applicant contained in the application or in any other record relating to the grounds on which the relief is sought. In addition, if the applicant resided in another state after the sentence was discharged, the application for relief by the pardon board shall contain a statement by the applicant consenting to the disclosure to the board of any data concerning the applicant that was collected or maintained by the foreign state relating to the grounds on which the relief is sought, including disclosure of criminal arrest and conviction records.