Request For Restitution - Victim Statement

OFFICE OF THE DISTRICT ATTORNEY - 18TH JUDICIAL DISTRICT

Victim Statement 

Note the * indicates a required field

Defendent/Offenders Name:

* First: 
Middle:

*
Last:

*Case No:

 
IF YOU DO NOT WISH TO MAKE A STATEMENT: PLEASE CHECK THIS BOX
  AND ENTER YOUR NAME AT THE BOTTOM OF THIS PAGE.
 

As a victim of crime, we want to give you the chance to share your feelings about how the crime has affected you. While we realize it may be hard to put it in writing, we feel it is important to have your thoughts. State in your own words how this crime has affected you and/or your family. This information will be kept in the official case file and will be made available to Pre-Sentence Investigation and the Judge before sentencing of the defendant/offender if convicted of the crimes charged.

 
*
Your Name:

Entering your name in the above field and clicking the submit button below constitutes your electronic signature of this form.