Victim Packet

You have been named a victim in a criminal case. Our office would appreciate some information from you to help us better assist you.

Please complete this form within 10 days and return it to our office. If we do not recieve this form back or contact from you, we will assume you do not wish to be a participating victim. This can result in loss of victim rights, by your choosing.

If you have any questions, please contact the Vermillion County Prosecutor's Victim Assistance Office at:

Call: 765-492-5379

Text: 765-492-5379

Email: kerri.langley@vermillioncounty.in.gov

Mailing Address: PO Box 249 Newport, IN 47966
VICTIM CONTACT INFORMATION
Instructions: the Prosecution of a criminal case is a process that necessitates the exchange information between this office and you as the victim in this case. As such, it is very important that you provide this office with accurate and current information that will allow for contact regarding any number of issues that arise during this case. It is your responsibility to provide this information and to update this information as need bc. Therefore, please fill out this form and return it to the Victim Assistance Coordinator. If the form is not completed and returned, then this office will assume that you are not interested in the progress of this case.
Name
DOB
Street Address
Mailing Address
Primary Phone #
Secondary Phone #
Email Address
example@example.com
Relationship to offender
CHECK ALL THAT APPLY:

HomelessVeteranDisabledHard of HearingLGBTQLimited English
What method do you prefer to be contacted by?

PhoneTextEmail
RESTITUTION REQUEST
As a result of the action of the Defendant, you may be entitled to restitution, at the discretion of the Court. The law allows you to receive restitution for (1) uninsured property damage, (2) lost wages, (3) uninsured medical and/or hospital bills provided that the same were incurred before the Sentencing Hearing, Any restitution request for property damage should be documented with receipts or estimates for replacements. Any medical or hospital bills must be documented with a copy of the bill. Lost wages must be on an employer's letterhead and must be signed by your employer. You are required to submit your losses to your insurance company, if coverage is available. Any deductible or damages not covered by your insurance company may be collected as restitution. Your insurance company has the means to collect their losses and they will be provided with whatever information is requested.

Restitution for Property Damage or Loss (including theft/stolen property): Amount requested: Explanation for amount requested: (Attach additional pages if necessary)
Amount requested
Explanation for amount requested:
VICTIM IMPACT STATEMENT
Instructions: As the victim in this case. you have the right to address the Court and express your opinion as to what you believe would be an appropriate sentence in this case (within the parameters allowable by law.) In other words, you are telling the Court, how this crime has affected your life.
You have the right to attend and testify in the final hearing. Is this something that you would be interested in?

YesNo
Would you like to continue to be informed on the progress of this case?

YesNo
I affirm under the penalties of perjury, that the foregoing statements are true and accurate to the best of my knowledge.
Name
Signature

Clear
Date
Should be Empty:

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VICTIM CONTACT INFORMATION

RESTITUTION REQUEST

VICTIM IMPACT STATEMENT