VICTIM RIGHTS NOTIFICATION FORM

VICTIM RIGHTS NOTIFICATION FORM
Filling out this form is voluntary. You do not have to complete every section. If you choose to fill out the form, Please submit it to our office at your earliest convenience.

If you have questions or concerns, please contact:

Marla Cox

Victim Services Coodinator

435-781-5436
Your Name:
Name of Defendant:
Please provide if known
Court Case No.:
9 digit number
STEP ONE:
Identify who will receive the notifications. CHECK ONLY ONE BOX
Victim Name
Please print your full legal name or full legal name of the victim
STEP TWO:
Provide a mailing address for the person designated above to receive notification.
Street Address:
Apt:
City:
State:
Zip:
STEP THREE:
Provide other contact information.
PHONE - Cell:
Home:
Work:
Email:
example@example.com
Preferred Contact Method:
STEP FOUR:
Choose what involvement you would like to have in the case. CHECK ANY THAT APPLY.
STEP FIVE:
Let us know what other rights you would like to exercise. CHECK ANY THAT APPLY
IF YOU ARE THE VICTIM OF A SEXUAL OFFENSE:
IF YOU ARE / REPRESENT A CHILD VICTIM:
STEP SIX
Sign and Return the form.
Date:

MonthDayYear
Date
Print / Type Name
Your initials constitute your digital signature.
Should be Empty:

STEP ONE: