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Request To Exercise Victims' Rights - State Of Mississippi Crime Victims' Bill Of Rights

STATE OF MISSISSIPPI

CRIME VICTIMS’ BILL OF RIGHTS

REQUEST TO EXERCISE VICTIMS’ RIGHTS

FOR VICTIM TO SIGN

I, ____________________________________, victim of the crime of ____________________________________,

(victim)

(crime committed)

committed on ________________, by ___________________________________ in _______________________,

(date)

(name of offender, if known)

(city, county)

request that I be given all 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

(victim representative)

(victim)

was the victim of the crime of ____________________________________committed on___________________, by

(crime committed)

(date)

____________________________________ in_________________________________ request that, on behalf of

(Name of offender, if known)

(city, county)

_____________________________, I be given all the rights provided in the Victims’ Bill of Rights, Mississippi Code

(victim)

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 (print)

__________________________________________________________________________________________________________________

ADDRESS (Street/P.O. Box)

(City)

(State)

(Zip)

(_______)__________________________________________________________________________________________________________

TELEPHONE NUMBER(S)

Mail this form to the Youth Court Prosecutor or Department of Human Services Youth Court

Counselor in your jurisdiction.

PLEASE NOTE: Until your case has been turned over to the prosecuting attorney, you will need to call

the Youth Court Counselor assigned to your case for an update.

Request To Exercise Victims' Rights - State Of Mississippi Crime Victims' Bill Of Rights