Request To Exercise Victim'S Rights Form printable pdf download

Request To Exercise Victim'S Rights Form

REQUEST TO EXERCISE VICTIM’S RIGHTS

For victim to sign:

I, ________________________________, victim of the crime of

____________________________,

committed on _________________________________, request that I be given all the rights

provided

in the Victims’ Bill of Rights, Mississippi Code Annotated, Section 99-43-1 et. seq. I

understand that it

is my responsibility to provide the prosecutor with any change in my name, address or

telephone

number in order to continue to exercise these rights.

For victim’s representative to sign:

I, _________________________________, representative of

______________________________,

who was the victim of the crime of

__________________________________________committed on

________________ request that, on behalf of ________________________________, I be

given all

the rights provided in the Victims’ Bill of Rights, Mississippi Code Annotated, Section 99-43-1

et. seq.

I understand that it is my responsibility to provide the prosecutor with any change in my name,

address or telephone number in order to continue to exercise these rights.

_________________________________

Name

Request To Exercise Victim'S Rights Form