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TEMPE CITY PROSECUTOR OFFICE VICTIM RIGHTS FORM 

As a victim of a crime in Arizona, you have the right to be treated with fairness and dignity and to be free from intimidation, harassment or abuse throughout the criminal justice process.  You have the right to appear at all the defendant’s court hearings, to be heard in court when the judge is determining release conditions or sentencing, and to consult with the prosecuting attorney. 

You also have the right to request that the prosecutor notify you of all the defendant’s court appearances and to request that the Court order the defendant to pay restitution for your financial losses that were a direct result of the crime.  Please indicate below if you wish to request your rights or waive (decline) your rights.  

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TEMPE CITY PROSECUTOR OFFICE VICTIM RIGHTS FORM As a victim of a crime in Arizona, you have the right to be treated with fairness and dignity and to be free from intimidation, harassment or abuse throughout the criminal justice process. You have the right to appear at all the defendant’s court hearings, to be heard in court when the judge is determining release conditions or sentencing, and to consult with the prosecuting attorney. You also have the right to request that the prosecutor notify you of all the defendant’s court appearances and to request that the Court order the defendant to pay restitution for your financial losses that were a direct result of the crime. Please indicate below if you wish to request your rights or waive (decline) your rights.

I request my rights as a victim	I waive/decline my victim rights
Victim Name:

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I am completing this on behalf of a victim who is under age 18, disabled or incapacitated.  

I am completing this on behalf of a victim who is under age 18, disabled or incapacitated.

My Name:

Relationship to Victim:

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Contact Information

Contact Information

Mailing Address:

City, State, and Zip Code:

Telephone: Home/Cell

Work (if you can receive calls)

E-mail:

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I prefer to receive notifications by:

I prefer to receive notifications by:

Regular Mail

E-mail

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I   AM    AM NOT   seeking restitution for financial losses that were a direct result of the crime. 

I understand that it is my responsibility to provide written documentation showing my out-of-pocket expenses (or written estimates).  IMPORTANT: Please e-mail, fax, or mail copies of bills, invoices, estimates, etc. to our office.

I AM AM NOT seeking restitution for financial losses that were a direct result of the crime. I understand that it is my responsibility to provide written documentation showing my out-of-pocket expenses (or written estimates). IMPORTANT: Please e-mail, fax, or mail copies of bills, invoices, estimates, etc. to our office.

AM	AM NOT
Total Amount:

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If you do not submit this form or otherwise notify our office, we will consider that you are declining your ‘upon request’ rights.  You may invoke or decline your victim rights at any time during the case process.

The Tempe City Prosecutor Office will keep your contact information confidential.  If a defendant or his attorney wishes to contact you, they are required to inform the Prosecutor Office; you have no obligation to speak to them.

I understand that it is my responsibility to notify the Tempe Prosecutor Office if there are any changes to my address, phone or e-mail address.  If I fail to do so, I may waive my victim rights.

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If you do not submit this form or otherwise notify our office, we will consider that you are declining your ‘upon request’ rights. You may invoke or decline your victim rights at any time during the case process. The Tempe City Prosecutor Office will keep your contact information confidential. If a defendant or his attorney wishes to contact you, they are required to inform the Prosecutor Office; you have no obligation to speak to them. I understand that it is my responsibility to notify the Tempe Prosecutor Office if there are any changes to my address, phone or e-mail address. If I fail to do so, I may waive my victim rights.

Victim or Lawful Representative Name:	Defendant Name:
Court Case No.

Mail or Hand Deliver:    Tempe City Prosecutor Office, 140 E 5^th St, Suite 303, Tempe AZ 85281

Fax:                             (480) 350-8987

E-mail:                          victimservices@tempe.gov

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