VICTIM`S RIGHTS NOTIFICATION FORM

VICTIM'S RIGHTS NOTIFICATION FORM
STATE OF IDAHO VS.
CASE NO:
VICTIM:
As a victim in the above-entitled case, I wish to be afforded the following rights:
___(1) To be permitted to be present at all criminal justice proceedings.
___(2) To be entitled to a timely disposition of this case.
___(3) To be given prior notification of trial court and appellate proceedings.
___(4) To be given information about the sentence, incarceration, or release of the defendant.
___(5) To be heard, upon request, at all criminal justice proceedings considering a plea of guilty,
sentencing, incarceration or release of the defendant--unless manifest injustice would result.
___(6) To be afforded the opportunity to communicate with the prosecution and to be advised of any
proposed plea agreement by the prosecuting attorney prior to entering into a plea agreement in
criminal offenses involving crimes of violence, sex crimes or crimes against children.
___(7) To be allowed to refuse an interview or other contact with the defendant or with any other person
acting on behalf of the defendant--unless such request is authorized by law.
___(8) To have your stolen or other personal property held by law enforcement agencies returned to
you as soon as it is no longer needed for evidence.
___(9) To be notified whenever the defendant is released or escapes from custody.
I have checked those rights which I wish to be afforded. In order to have these rights made
available to me, I shall notify the Kootenai County Prosecuting Attorney's Office if there is any change in
my address or phone number.
__________________________
(Signature)
Send to:
Name: __________________________ Kootenai County Prosecuting Attorney
Address: _______________________
City/State: ____________________
P.O. Box 9000
Home Phone: ___________
Coeur d'Alene, Idaho 83816-9000
Work Phone: ___________________
VICTIM IMPACT STATEMENT
VICTIM:
RE: STATE OF IDAHO VS.
STATE OF IDAHO VS.
1.
Please describe the impact of this crime on your life and/or the life of your family members.
Indicate whether or not you or family members were threatened during or after the course of the
incident. Special attention should be given to describing the physical and/or emotional impact
resulting from this offense.
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2.
Did you require medical treatment for the injuries sustained? YES ____ NO ____
If yes, describe the treatment received and the length of time treatment was or is required.
_________________________________________________________________
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Amount of expenses incurred to date as a result of medical treatment received:
$__________________
Anticipated Expenses: $__________________
3.
Were you psychologically injured as a result of this incident? YES ____ NO ____
If yes, please describe the psychological impact which the incident has had on you.
_________________________________________________________________
_________________________________________________________________
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Have you received any counseling or therapy as a result of this incident? YES ____ NO ____
If yes, please describe the length of time you have been or will be undergoing counseling or
therapy and the type of treatment you have received:
_________________________________________________________________
_________________________________________________________________
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Amount of expenses incurred to date as a result of counseling or therapy received:
$___________
4.
Has this incident affected your ability to earn a living? YES ____ NO ____
If yes, please describe your employment, and specify how and to what extent your
ability to earn a living has been affected, days lost from work, etc.:
_________________________________________________________________
_________________________________________________________________
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5.
Have you incurred any other expenses or losses as a result of this incident?
YES ____ NO ____ If yes, please specify the amount and nature of any expenses or
losses:
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6.
Did insurance cover any of the expenses you have incurred as a result of this incident?
YES ____ NO ____ If yes, please specify the amount and nature of any reimbursement:
_________________________________________________________________
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7.
Do you have any thoughts or suggestions on the sentence which the Court should impose
herein? Please explain, indicating whether you favor imprisonment:
_________________________________________________________________
________________________________________________________________
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8.
If possible, please attach copies of all records necessary to support the injuries and losses
described before. This includes any medical bills, official records of days lost from your
employment, any estimates of value of stolen or damaged property, and any receipts for
replacement of stolen or damaged property.
Date: ____________
Signature: ____________________________
PRIVACY ACT STATEMENT: There is no statutory authority for the collection of this information.
This information could be used for purposes of determining the full impact of a crime upon a
victim, for the purposes of obtaining court-ordered restitution for the victim, and for assisting the
Kootenai County Prosecuting Attorney's Office with your case. Disclosure of this information is
voluntary. Failure to disclose may result in an inadequate assessment of victims needs for the
application of court-ordered restitution.
RETURN TO:
Kootenai County Prosecuting Attorney's Office
P.O. Box 9000
Coeur d'Alene, Idaho 83816-9000