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Crime Victim Impact Form

  1. OFFICE OF THE PROSECUTING ATTORNEY

  2. VICTIM/WITNESS SERVICES DIVISION

  3. 411 Jules, Room 132, St. Joseph, Missouri 64501

  4. Crime Victim Impact Form

  5. All victims of crime suffer in one way or an other. Please complete and submit this form so we can tell the judge at sentencing how the impact of this crime has affected your life.

  6. Defendant Information:

  7. Victim Information:

  8. Relationship to victim:

  9. Crime Impact Information

  10. Restitution Claim:

  11. Nature of your claim?

    (Check all that apply.)

  12. Are any of these items covered by insurance?

  13. (Bring copies of bills, receipts, estimates, etc. to our office.)

  14. (Describe)

  15. Crime Victims' Rights

  16. As a crime victim you have several rights resulting from the passage of the Missouri Constitutional Amendment for Crime Victims in 1992 (Chapter 595.209, RSMo.). Among the constitutionally guaranteed rights, is the right to be informed of court dates and sentencing decisions upon written request. If you would like to be informed of court dates related to the above-named defendant, please check the appropriate box.

  17. Please select one:

  18. Leave This Blank:

  19. This field is not part of the form submission.