Office of the State's Attorney for Baltimore City

Victim Impact Statement

The following is a standard victim impact statement form that can be completed and submitted online. Complete as much of the following document as you can. When you have finished, be sure to read over the document and then hit the send button to submit it.

If you have questions during this process, do not hesitate to contact our Victim and Witness Division at 410-396-1897.

Defendant Information

Defendant's Name*:
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Case Number*:
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Victim Information

Your Name*:
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Your Phone Number*:
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Your Email Address:
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Shield your contact information in court:
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Incident Location

Incident Location*
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I. Emotional/Physical Impact

(Describe the emotional or physical impact the crime has had on you, your family, friends and/or community. Please describe any changes in your life or your community as a result of this crime and any additional information you would like the court to consider about the impact this crime has had on your life, such as changes in personal welfare, lifestyle, or family relationships)

Emotional/Physical Impact
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II. Financial Impact

(List any property damage, personal property loss, medical expenses - current and future: counseling expenses, funeral/burial expenses, lost wages/income loss, and any other expenses incurred as a result of being victimized.

Financial Impact
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III. Sentencing Recommendation

(Discuss what sentence you would like to see the judge impose on the defendant - jail time, community service, counseling, no contact order - any other information you want the judge to know. Restitution requests should be made in this section)

Sentencing Recommendation
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IV. Other Information that You Want to Include

Other Information that You Want to Include
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reCAPTCHTA
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Submit