VICTIM INFORMATION FORM

This information will be used by the Prosecuting Attorney to assist in trial preparation. It will not be disclosed directly to the defense. If you have any questions, please feel free to contact our office.

Victim's Name: *

Victim's Address: *

Phone Number *

Is it okay to leave a message? *

Yes

Alternate Phone Number

Is it okay to leave a message?

Yes

Email Address *

Preferred method of Contact *

Offenders Name: *

Does anyone else have information regarding the case:

In your own words, briefly describe the crime that was committed against you/your family: *

Please state what penalty you would like for the Prosecutor to request in regard to the defendant: *

If you are human, leave this field blank.