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PLEASE LIST ANY COMPENSATION THAT YOU HAVE ALREADY RECEIVED:

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RESTITUTION: Give your opinion of whether the person convicted of the crime should pay

you money for your loss, or do work as part of the sentence and how much.

______________________________________________________________________________

SENTENCING: Please write your thoughts and opinions on what the judge should do to punish

the offender and/or to deter the offender from repeating this crime.

______________________________________________________________________________

ANY OTHER COMMENTS OR CONCERNS THAT YOU WOULD LIKE TO EXPRESS:

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Please be advised that this Victim Impact Statement will be made available to the judge, assistant

prosecuting attorney, probation officer, defense attorney and defendant. All of the information

you submit on this statement could be read by all of the above parties.

I swear that the statements made here are true to the best of my knowledge.

Signature: _____________________________________

Date: _______________________

Please print your name: __________________________________________________________

If you are completing this statement for someone else, please complete the following:

Victim’s Name: ____________________________

Your relationship to victim: __________

You may add to this statement at any time.

Please complete and return to:

Macomb County Prosecutor’s Office

Crime Victims Rights Unit

1 South Main, 3

Floor

Mt. Clemens, MI 48043

Victim Impact Statement Form - Macomb County Prosecutor'S Office Crime Victims Rights Unit Page 2