VCVA Victim Packet

You have been named a victim in a criminal case. To better assist you in this case we do need some information from you.

Please complete this form within 10 days and return it to our office. If we do not receive 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 photos of details from your case please email them to: kerri.langley@vermillioncounty.in.gov

You can also visit our website at www.vermcova.com for more information!

If you have any questions, please contact us at:

Vermillion County Prosecutor's Office Courthouse 1st Floor

255 S. Mail Street

PO Box 249 Newport, IN 47966-0249

Office: 765-492-5379

Text: 765-492-5379

Fax: 765-492-5371
VICTIM CONTACT INFORMATION
Instructions: The Prosecution of a criminal case is a process that necessitates the exchange of 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 be. 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. Email address may be used by the court and myself for quick and reliable correspondence of court dates and important information.
Name
DOB
Street Address
Mailing Address
Primary Phone #
Format: (000) 000-0000.
Secondary Phone #
Format: (000) 000-0000.
Preferred contact method:

PhoneTextEmailLetter
EMAIL ADDRESS
example@example.com
Relationship to offender
Mark all that apply:

HomelessVeteranDisabledHard of Hearing/DeafLGBTQLimited English
Do you wish to be contacted and kept up to date on this case?

YESNO
RESTITUTION REQUEST
As a result of the action of the above-named 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, 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.

LACK OF COOPERATION IN THE CASE OR UNTIMELY RETURN OF REQUIRED PAPERWORK COULD RESULT IN THE RESTITUTION REQUEST BEING FORFIETED.
Amount requested for Property Loss or Damage
Medical or Hospital Bills
Lost Wages 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 testify at the Sentencing Hearing. Is this something you are interested in?

YESNO
Signature
Printed Name
Date
Should be Empty:

VICTIM CONTACT INFORMATION

RESTITUTION REQUEST

VICTIM IMPACT STATEMENT