Fillable Request For Victim Services Cdcr 1707 - California printable pdf download

REQUEST FOR VICTIM SERVICES

STATE OF CALIFORNIA

CDCR 1707 (Rev. 10/11) (Front)

DEPARTMENT OF CORRECTIONS AND REHABILITATION

California Department of Corrections and Rehabilitation (CDCR)

Office of Victim and Survivor Rights and Services (OVSRS)

P.O. Box 942883, Sacramento, CA 94283-0001

Toll Free Number: 1-877-256-6877 Fax Number: (916) 445-3737

. A

O NOT MAIL THE COMPLETED FORM TO A PRISON

LL INFORMATION WILL REMAIN CONFIDENTIAL

Check one:

New/Revised Request for Victim Services

Change of address/phone/e-mail only

(complete sections A, E, and F)

A. APPLICANT INFORMATION (Must be completed.)

ECTION

Check one:

Victim of crime(s) committed by offender

Witness who testified against the offender

Family member of victim (next of kin), indicate relationship:

Print Applicant Name:

Circle Mr./Mrs./Ms.

(FIRST)

(MIDDLE)

(LAST)

Home Address:

(STREET)

(CITY)

(COUNTY)

(STATE)

(ZIP CODE)

Mailing Address:

___

(IF DIFFERENT)

(STREET)

(CITY)

(COUNTY)

(STATE)

(ZIP CODE)

Telephone:

(DAYTIME)

(EVENING)

(CELL)

(E-MAIL)

: It is your responsibility to keep the OVSRS informed of any changes to your personal information.

OTE

B. NOTIFICATION OF OFFENDER STATUS IN STATE PRISON (Complete if you want to request notification.)

ECTION

1. To be notified of the release, escape, or death of an offender, check one of the boxes (a, b, or c) below:

Send me notification by mail; or

phone and/or

e-mail notification instead of

notification by mail, or

I registered through VINE at 1-877-411-5588 or online at

to receive phone and/or e-mail

notification and do not need notification by mail.

Notify me of the offender’s criminal appeal. (Note: Checking this box means your information will be shared with the

California Attorney General’s Office to notify you of the offender’s criminal appeal.)

∗ ∗ ∗ ∗ ∗

FOR VICTIMS/VICTIMS’ FAMILY MEMBERS (NEXT OF KIN) ONLY

1.To be notified of parole hearing date(s) for an offender sentenced to life imprisonment, check one of the boxes below:

Send me notification by mail; or

phone and/or

e-mail notification instead of notification by mail.

Note: May we share your contact information with the district attorney’s office where the trial was held?

Yes

2.To be notified of the scheduled execution of an offender sentenced to death, check this box.

C. CONDITIONS OF PAROLE/COMMUNITY SUPERVISION (Complete if you want to request special conditions.)

ECTION

Requests for special conditions of parole/community supervision are considered but not guaranteed.

I request the following conditions when the offender is released on parole/community supervision:

Offender not be allowed to contact me while he/she is on parole/community supervision

Offender not be allowed to live in the same county that I live in

For victims/witnesses only:

Offender not be allowed to live within 35 miles of my home address

(available only for specific types of crimes, see reverse)

: If you would like to provide additional information explaining your request, attach a separate sheet of paper.

OTE

D. RESTITUTION (Complete if you have a court order to receive restitution.)

ECTION

There is a restitution court order in the amount of $_____________ payable to

(name):

: To be determined (TBD) orders must be finalized by the county before CDCR can collect restitution.

OTE

E. OFFENDER IDENTIFICATION (Complete as much information as possible.)

ECTION

Offender’s Full Name

(Print):

Date of Birth:

(FIRST)

(MIDDLE)

(LAST)

MO / DAY / YEAR

CDCR Number

Date Sentenced to State Prison

(Prison Number):

MO / DAY / YEAR

Court Case Number:

County of Commitment:

F. APPLICANT SIGNATURE (Sign and date the completed form.)

ECTION

Signature of Applicant:

Date:

Request For Victim Services Cdcr 1707 - California

Related Articles

Related forms

Related Categories