Victim Impact Statement Form - Macomb County Prosecutor'S Office Crime Victims Rights Unit

ADVERTISEMENT

VICTIM’S IMPACT STATEMENT
Macomb County Prosecutor’s Office
Crime Victims Rights Unit
Defendant: _________________________________ File No.: __________________________
PLEASE PRINT OR TYPE. If you need additional space, please feel free to attach extra pages.
This form will allow the sentencing judge and the prosecutor to know your feelings about being a
victim of crime and how the crime affected you. Some sections may not apply to you, please
leave those sections blank.
VICTIM’S PERSONAL REACTION: Write your feelings on how being the victim of this
crime has affected you personally, as well as those around you.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
VICTIM’S PHYSICAL OR EMOTIONAL INJURY: Explain any injuries and the treatment that
you received. Attach copies of any bills.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
VICTIM’S PROPERTY LOSS: List any property that was damaged, destroyed or lost, as well
as the value of that property. Attach copies of bills or estimates for repair.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
FINANCIAL OR OTHER LOSS: List the days and hours you missed from work because of this
crime and the amount of wages that you lost.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
COMPENSATION: List any agency or company to which you have applied for replacement or
to loss coverage. (i.e. Insurance, Medicaid, Crime Victim’s Compensation)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
OVER

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Open Public Records Act Request Form - Morris County Prosecutor's Office Open Public Records Act Request Form - Morris County Prosecutor's Office Business
Schedule Of Leased Equipment And Fixtures Located In Sacramento County As Of January 1 Form - Sacramento County Assessor's Office Schedule Of Leased Equipment And Fixtures Located In Sacramento County As Of January 1 Form - Sacramento County Assessor's Office Legal
Ocso Form 3601 - Veteran's Preference Form - Okaloosa County Sheriff's Office Human Resources Section Ocso Form 3601 - Veteran's Preference Form - Okaloosa County Sheriff's Office Human Resources Section Legal
Citizen's Complaint Form - Monterey County Sheriff's Office Citizen's Complaint Form - Monterey County Sheriff's Office Legal
Jpay Money Order Deposit Form - Pasco County Sheriff's Office Jpay Money Order Deposit Form - Pasco County Sheriff's Office Business
Unclaimed Property Form - Monterey County Sheriff's Office Unclaimed Property Form - Monterey County Sheriff's Office Legal
Records Request Form - Adams County Sheriff's Office Records Request Form - Adams County Sheriff's Office Business
Personal Property Proration Form - Charleston County Auditor's Office Personal Property Proration Form - Charleston County Auditor's Office Legal
Ati Real Property Tax Exemption Form - Sumter County Assessor's Office Ati Real Property Tax Exemption Form - Sumter County Assessor's Office Legal
Affidavit For Property Tax Exemption Form - Sumter County Assessor's Office Affidavit For Property Tax Exemption Form - Sumter County Assessor's Office Legal

Related Categories

Parent category: Legal
Download
Go
Page of 3