Welcome To The State Attorney’s Office, 18th Judicial Circuit:

PLEASE FOLLOW THESE DIRECTIONS
WHEN COMPLETING YOUR
LEO VICTIM IMPACT STATEMENT

Please use the information contained in the letter to complete the Defendant's Name and the Case Number on the form.
Please complete as much information as possible on the form.
After completed, please print a copy for your records.
If you have receipts, estimates, or any other additional information pertaining to your losses, please print the COMPLETEDform, attach copies and either mail or fax. DO NOT SEND ORIGINALS.
By clicking the SUBMIT button, you automatically forward the form to the Victim Witness Service's email address.

BREVARD COUNTY LAW ENFORCEMENT:

You may fax the form to: 321-617-7556
You may courier in Brevard to: VWS/State Attorney's Office - #84

SEMINOLE COUNTY LAW ENFORCEMENT:

You may fax the form to: 407-665-6004
You may courier in Seminole to: VWS/State Attorney's Office Justice Center - 2nd Floor

LAW ENFORCEMENT - VICTIM IMPACT STATEMENT

* are Required

*State of Florida vs.
Court Case Number: case number- followed by (MMA), (CFA), or (CJA)
Brevard Case Seminole Case

VICTIM CONTACT INFORMATION

PHONE#:
*Home:
*Work:
*Cell:
*Email:

VICTIM COMMENTS

How has the crime affected you as a law enforcement officer?
What (if any) hardships have you experienced as a result of this crime?

PHYSICAL INJURIES/DAMAGES

Did you receive any injuries as a result of the crime?
If so, were injuries covered by Workman's Compensation?
Please give a brief summary about your injuries.

Was anything stolen or damaged as a result of this crime?
If so, please give a brief summary.

VWS ASSISTANCE /COURT ATTENDANCE REQUEST

Please select what Victim Witness Services can provide you.

Court Case Information: Supportive Services:
I wish to attend all court proceedings:
I wish to attend necessary court proceedings:
I do not wish to attend any court proceedings (other than my legal requirements.):

Law Enforcement Officer:
Badge #:
Date: