Free CONFIDENTIAL REQUEST FOR NOTIFICATION OF STATUS OF INMATE - Connecticut


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Date: August 28, 2008
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State: Connecticut
Category: Court Forms - State
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CONFIDENTIAL REQUEST FOR NOTIFICATION OF STATUS OF INMATE
JD-VS-5 Rev. 3-07 C.G.S. ยงยง 18-81e, 54-228, 54-231

INSTRUCTIONS STATE OF CONNECTICUT 1. Complete as much of the information as you can. OFFICE OF VICTIM SERVICES 2. You may submit this form to either the Office of Victim Services (OVS) or JUDICIAL BRANCH the Department of Correction (DOC). 3. The addresses where you may send the completed form are shown below. www.jud.ct.gov 4. If you have any questions regarding the submission of your completed form, contact OVS at 1-800-822-8428 or DOC at 1-888-869-7057.

TO: Office of Victim Services, 225 Spring Street, Wethersfield, CT 06109 and TO: Department of Correction - Victim Services Unit, 24 Wolcott Hill Road, Wethersfield, CT 06109
FROM (Your name) DAYTIME PHONE NO. EVENING PHONE NO. CELL PHONE NO.

MAILING ADDRESS TO WHICH YOU WANT NOTIFICATION SENT (Number, apt. no., street, town and zip code) EMERGENCY CONTACT - IN CASE OF EMERGENCY AND YOU CANNOT BE REACHED (Give name and telephone no )

Do we have your permission to leave a message on your answering machine or voice mail? Check the box below that explains your relationship to the victim or inmate:
SELF PARENT/LEGAL GUARDIAN LEGAL REPRESENTATIVE DECEASED VICTIM'S IMMEDIATE FAMILY MEMBER STATE'S ATTORNEY INMATE'S IMMEDIATE FAMILY MEMBER
NAME OF INMATE TOWN WHERE CRIME OCCURRED ARREST DATE

YES

NO

DEPT. OF CORRECTION NO. OR DOCKET NO. SENTENCING DATE SENTENCING COURT G.A.

Please notify me if the inmate named above (Check all that apply):
Applies for a pardon, parole, release from prison other than a furlough (discharge, halfway house, etc.) or change in sentence. Is scheduled to be released from a correctional facility other than on a furlough, except a reentry furlough. Applies for an exemption from the registration requirements of the Sex Offender Registry. Applies for a restriction of the disclosure requirements of the Sex Offender Registry. Dies while in custody. Transfers to a community release program (DOC only). Escapes/returns from escape (DOC only). Provide a brief description of how you were victimized by this offender. (Include any dates that pertain to the incident.)

Are you listed as the protected party on an order of protection in which the inmate named above is the subject?
DATE ORDER ISSUED NAME OF ISSUING COURT

YES*

NO

* If yes, complete this section:

TYPE OF ORDER

PROTECTIVE ORDER

STANDING CRIMINAL RESTRAINING ORDER

RESTRAINING ORDER

NO-CONTACT ORDER

I understand that it is my responsibility to notify the Office of Victim Services and the Department of Correction - Victim Services Unit of any change in my mailing address or telephone number(s) and that this request and any notices of change of address shall be kept strictly confidential and shall not be disclosed by the Office of Victim Services or the Department of Correction.

SIGNED

X

DATE SIGNED
ADA NOTICE The Judicial Branch of the State of Connecticut complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation in accordance with the ADA, contact the Office of Victim Services or the Department of Correction - Victim Services Unit at the addresses shown above.

NOTICE: Keep a copy of this request for your records. Acknowledgment will be sent to you within thirty (30) days. If you do not receive an acknowledgment, contact OVS at 1-800-822-8428 or DOC at 1-888-869-7057.

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