Form Cdcr 1707 - Request For Victim Services Form
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1
2STATE OF CALIFORNIA
DEPARTMENT OF CORRECTIONS AND REHABILITATION
REQUEST FOR VICTIM SERVICES
CDCR 1707 (Rev. 04/08 Internet)
California Department of Corrections and Rehabilitation (CDCR)
Office of Victim and Survivor Rights and Services (OVSRS)
P.O. Box 942883, Sacramento, CA 94283-0001
Toll Free Number (877) 256-6877 Fax Number (916) 445-3737
D
O NOT MAIL COMPLETED FORM TO A PRISON
Check one:
New/Revised Request for Victim Services
Change of address only
(complete sections A, E, and F)
S
A. APPLICANT INFORMATION
ECTION
Check one:
Victim (direct victim of inmate)
Witness
Concerned Citizen
Family member of victim (next of kin), indicate relationship:__________________________
Print Applicant Name:
____________________________________________________________________
Circle Mr./Mrs./Ms.
(FIRST)
(MIDDLE)
(LAST)
Home Address:
_
(STREET)
(CITY)
(COUNTY)
(STATE)
(ZIP CODE)
Mailing Address
:
_
(If Different)
(STREET or P.O. BOX)
(CITY)
(STATE)
(ZIP CODE)
Telephone:
(______)__________________
(______)__________________ (______)__________________ ___________________________
(DAYTIME)
(EVENING)
(CELL)
(EMAIL)
N
: It is your responsibility to keep the OVSRS informed of any changes to your personal information.
OTE
S
B. NOTIFICATION OF INMATE STATUS IN PRISON
ECTION
I request the following notification service(s) about the status of the inmate in prison:
Notification of release, escape, or death of an inmate
Notification of inmate’s criminal appeal (Note: Checking this box will allow us to share your information with the
California Attorney General’s Office.)
For victims/next of kin only:
Notification of parole hearing (applies only to inmates sentenced to a prison term that includes a life sentence)
May we share your contact information with the district attorney’s office where the trial was held?
Yes
No
S
C. CONDITIONS OF PAROLE FOR INMATE
ECTION
N
: Requests for special conditions of parole are considered but not guaranteed.
OTE
I request the following conditions when the inmate is released on parole:
Parolee not be allowed to contact me while he/she is on parole
Parolee not be allowed to live in the same county that I live in
For victims/witnesses only:
Parolee not be allowed to live within 35 miles of my home address
(available only for specific types of crimes - see instructions)
N
: If you would like to provide additional information explaining your request, attach a separate sheet of paper.
OTE
S
D. RESTITUTION
ECTION
There is a restitution court order in the amount of $_____________ payable to
___________________________.
(name):
N
: To be determined (TBD) orders must be finalized by the county before CDCR can collect restitution.
OTE
S
E. INMATE IDENTIFICATION
ECTION
Please provide as much of the following information about the inmate as possible:
Inmate’s Full Name (Print):
Date of Birth:
/
/
(FIRST)
(MIDDLE)
(LAST)
MO
DAY
YEAR
:
CDC Number (Prison Number):
Date Sentenced to State Prison
/
/
MO
DAY
YEAR
Court Case Number:
County of Commitment:
S
F. APPLICANT SIGNATURE
ECTION
Signature of Applicant:______________________________________________________Date:_______________________
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