Fillable Request For Victim Services Cdcr 1707 - California (Page 2 of 2) in pdf

REQUEST FOR VICTIM SERVICES

STATE OF CALIFORNIA

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

DEPARTMENT OF CORRECTIONS AND REHABILITATION

N S T R U C T I O N S

Read the following instructions carefully to fill out the front side of the form so that it can be processed correctly. Sections A,

E, and F must be completed. Complete all other sections, based on your needs. All information will remain confidential.

Check one of the two boxes at the top of the CDCR 1707 form to indicate if this is a new/revised request or a change of

address/phone/e-mail only. If you check “Change of address/phone/e-mail only,” complete sections A, E, and F only.

A. A

C. C

ECTION

PPLICANT

NFORMATION

ECTION

ONDITIONS OF

AROLE

OMMUNITY

UPERVISION

This section must be completed. Check the box that most

Complete this section if you choose to request special

accurately describes your relationship to the offender: victim,

conditions of parole/community supervision. Such conditions

witness, or family member of victim (next of kin) and your

are not guaranteed but you may check all that you wish to

relationship to the victim.

request or are eligible to receive.

Circle the appropriate title: Mr., Mrs., or Ms. Clearly print your

Check Box 1 to request that the offender have no contact

name, home address, mailing address (if different), your

with you while he/she is on parole/community supervision.

daytime, evening, cell phone numbers and e-mail address (if

you have one).

Check Box 2 to request that the offender not be allowed to

live in the same county that you live in.

: It is your responsibility to keep the OVSRS informed of

OTE

any changes to your personal information.

The third box applies to victims and witnesses only.

Check Box 3 to request that the offender not be allowed to

ECTION

OTIFICATION OF

FFENDER

TATUS IN

RISON

live within 35 miles of your home address. Per Penal

Complete this section if you choose to request notification

Code Section 3003, available only for the following crimes:

services. Check the most appropriate box(es).

murder or voluntary manslaughter, mayhem, rape, sodomy

You have one of three choices to receive notice of an

by force, oral copulation, lewd acts on a child under 14, any

offender’s release, escape, or death. Check Box 1a to

felony punishable by death, stalking, and assault with a great

bodily injury enhancement.

indicate you would like OVSRS to register you through VINE to

receive phone and/or e-mail notification instead of notification

D. R

ECTION

ESTITUTION

by mail. Check Box 1c to let OVSRS know that you already

Complete this section if you have a court order requiring the

registered

through

VINE

phone

offender to pay you restitution and would like to provide the

to receive

1-877-411-5588 or online at

OVSRS with information to verify that our restitution records

phone and/or e-mail notification and do not need notification by

are complete. If your court order for restitution states “TBD”

mail.

for the dollar amount, contact the district attorney’s office to

request that a motion be filed to determine the restitution

Check Box 2 to allow the OVSRS to share your information

amount.

with the California Attorney General’s Office to notify you of the

status and outcome of any criminal appeal filed by the

E. O

ECTION

FFENDER

DENTIFICATION

offender in this case.

Provide as much information as you can in this section so

In the area marked F

’ F

we can be sure that we have the correct offender involved in

ICTIMS

AMILY

EMBERS

) O

, if you are the victim or the family member

your case. If you need help completing this section, you

EXT OF

NLY

of a victim, check Box 1a to register to receive notification by

may contact the district attorney’s office in the county where

mail of the date of an offender’s parole hearing only if the

the trial was held.

offender has been sentenced to life imprisonment. Check

Box 1b to ask the OVSRS to

F. A

ECTION

PPLICANT

IGNATURE

In addition,

by phone and/or e-mail instead of notification by mail.

Sign and date the completed form.

check yes to allow the OVSRS to share your information with

the district attorney’s office where the trial was held. The

The information requested is

ROVIDING

NFORMATION

district attorney’s office may be in contact with you if there is a

necessary to process your request for victim services and is

parole hearing for an offender with a life sentence. Check no if

voluntary.

Failure to provide any of the information

you do not want the OVSRS to share your information. Check

requested may prevent the OVSRS from processing your

Box 2 to request to receive notification of the scheduled

request. All information will remain confidential.

execution of an offender sentenced to death.

(

)

S U B M I T C O M P L E T E D F O R M B Y M A I L

F A X O R E

M A I L

S C A N N E D C O P Y

T O

California Department of Corrections and Rehabilitation

Office of Victim and Survivor Rights and Services

P.O. Box 942883

Sacramento, CA 94283-0001

Fax: (916) 445-3737 / E-mail:

ovssinet@cdcr.ca.gov

AGENCY PRIVACY STATEMENT:

The California Department of Corrections and Rehabilitation (CDCR), Request for Victim Services,

CDCR 1707. OFFICE RESPONSIBLE FOR FORM: Office of Victim and Survivor Rights and Services, P.O. Box 942883, Sacramento, CA

94283-0001. The telephone number is 1-877-256-6877. AUTHORITY: Penal Code Section 679.03, 2085.5, and 3058.8.

Request For Victim Services Cdcr 1707 - California Page 2

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