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VICTIM NOTIFICATION REQUEST FORM 

Date & Time: 
 
  Offender Last Name:
  Offender First Name:
  Date of Offense: Calendar
  DOB: Calendar
  Docket Number:
  County of Conviction:
  Offense(s):
(Character Limit = 1000)  
   
 
 
Per O.C.G.A. 17-17-3(11)...Victim means: (A) A person against whom a crime has been prepetrated or has allegedly been perpetrated; (B) In the event of the death of the crime victim, the following relations: the spouse; an adult child; a parent; a sibling; or grandparent; (C) A parent, or legal guardian of a crime victim who is a minor or a legally incaoacitated person.

Per O.C.G.A. 17-17-5 (Crime Victims' Bill of Rights) As the victim of a crime committed in the State of Georgia, you have right to be notified of release or escape from secure confinement.

 
  Victim Information:
 
  Victim Last Name:
  Victim First Name:
  Relationship with Victim:
  Mailing Address:
  City:
  State:
  Zip Code:
  Day Telephone: (XXX-XXX-XXXX)
  Evening Telephone: (XXX-XXX-XXXX)
  Cellular: (XXX-XXX-XXXX)
  Email id (if applicable):
 
   

   
 

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