Crime Victim Toolkit: Notice Requests, Impact Statements, Restitution, and Claims

Summary. Nine working templates, with notes on what each is for and the mistake each one prevents.

How to use these

Every template here is deliberately plain. Nothing in a victims' rights statute requires a particular form of words, and a letter that sounds like a person wrote it lands better than one that sounds like a form. What matters is that the request is in writing, that it is dated, that it identifies the case number, and that you keep a copy. The single most common failure in this area is not that a right was denied — it is that no one can prove it was ever asserted.

Fill the brackets. Delete what does not apply. Send by email where you can, so you have a timestamp.

Template 1 — Notification registration letter

Send to: prosecutor's victim-witness unit, court clerk, jail, corrections, probation/parole. One letter, five recipients. Re-send whenever your address, phone, or email changes.

RE: Victim notification registration — State v. [Defendant], Case No. [XXXX]

To whom it may concern:

I am the victim in the above matter. I am writing to register for notification of all proceedings and custody status changes, and to confirm my contact information.

Name: [Full name] Case number: [XXXX] Defendant: [Name] Mailing address: [Address] Phone: [Number] Email: [Address] — this is the most reliable way to reach me

I request notice of: all court dates and any change to a scheduled date; any plea offer or plea hearing; sentencing; any change in the defendant's custody status, including release, transfer, escape, furlough, or work release; and any parole, probation, or early-release consideration.

Please confirm receipt of this registration in writing.

[Signature] · [Date]

Note. Ask each office to confirm. Keep the confirmations together. If you later miss a hearing because notice went to an old address, the confirmation letter is the difference between a fixable clerical error and a dead end.

Template 2 — Conferral and plea-consultation request

Send to the assigned prosecutor early — ideally within the first month, long before a plea is on the table. The right to confer is worth little if it is asserted the morning of a plea hearing.

RE: Request to confer — State v. [Defendant], Case No. [XXXX]

Dear [Prosecutor]:

I am the victim in this case. I am asserting my right to confer with your office and my right to be heard at proceedings.

I request that someone from your office speak with me before any plea offer is extended or accepted, and before sentencing. I understand the charging decision is yours; I would like the opportunity to give you information before it is made.

Specifically, I want you to know:

[What happened, in two or three sentences.]

[How it has affected me — medically, financially, at work, at home.]

[What I am asking for: a no-contact condition, restitution in the amount of $____, notification of release, a particular sentencing outcome.]

[What I am worried about: safety, contact from the defendant or third parties, my address becoming public.]

I am reachable at [phone] and [email]. Please tell me the name and direct contact information of the advocate assigned to this case.

[Signature] · [Date]

Note. The last line does more work than it looks like it does. A named advocate with a direct line is the difference between a case you can track and one you cannot.

Template 3 — Restitution loss worksheet

The single most consequential document in this toolkit. Restitution is generally limited to losses documented before sentencing, and a court cannot order what nobody proved.

Category	Item	Amount	Documentation attached	Insurance paid	Net loss
Medical	Emergency department	$	Itemized bill + EOB	$	$
Medical	Follow-up / specialist	$		$	$
Medical	Prescriptions	$	Pharmacy printout	$	$
Medical	Medical equipment	$	Receipt	$	$
Medical	Mileage to treatment	$	Log × [rate]	—	$
Mental health	Sessions to date	$	Invoices	$	$
Mental health	Projected future sessions	$	Provider letter: ___ sessions × $___	—	$
Lost income	Days missed — injury	$	Pay stubs before/after + employer letter	—	$
Lost income	Days missed — court appearances	$	Subpoenas + timesheet	—	$
Lost income	Lost benefits or leave used	$	HR statement	—	$
Property	Items taken	$	Receipts or comparable listings	$	$
Property	Items damaged	$	Two repair estimates	$	$
Property	Items held as evidence	$	Property receipt	—	$
Security	Lock replacement / devices	$	Invoice	—	$
Security	Relocation costs	$	Lease, movers, deposits	—	$
Other	Childcare for hearings	$	Provider receipts	—	$
Other	Transportation and parking	$	Receipts	—	$
Other	Phone number change	$	Carrier invoice	—	$
Other	Crime scene cleanup	$	Invoice	$	$
Funeral	Services, burial, transport	$	Itemized funeral bill	$	$
				TOTAL	$______

Three notes that matter more than the table.

Include projections with a basis. "My therapist recommends weekly sessions for another year at $150" — attached in a one-paragraph provider letter — is a documented future loss. "I will probably need more therapy" is not. Restitution is generally fixed at sentencing, so a projection you leave out is money you do not get later.
Net out insurance, but show the gross. The court wants to see the full loss and what was already covered. The uncovered remainder is what gets ordered.
One page on top. Put a single summary sheet with category subtotals and a grand total in front of the pile of receipts. Whoever reads it is reading twenty other files that week.

Template 4 — Victim impact statement scaffold

Read the whole scaffold, then throw away the parts that are not true for you. The best statements are specific and short.

Victim Impact Statement — State v. [Defendant], Case No. [XXXX]

Who I am. [One or two sentences. Not your résumé — the version of your life the case interrupted. "I have driven the same route to the same job for eleven years."]

What happened, from where I was standing. [Three or four sentences. Not a re-litigation of the evidence. What you experienced.]

What changed. [The heart of it. Concrete, before-and-after. "I used to close the shop alone on Fridays. I have not closed alone since. My daughter now drives forty minutes each way to sit in the back office while I count the drawer."]

Physically. [Injuries, treatment, what still hurts, what you cannot do.]

Financially. [Costs, missed work, what you gave up. Keep it brief — the restitution worksheet carries the numbers.]

Other people. [Who else absorbed this. Children, a spouse, an employee, a parent.]

Where things stand now. [Honest. Recovery, or not. What you are still carrying.]

What I am asking the court. [Only if your jurisdiction allows an opinion on the sentence. Ask the advocate first. If allowed: state it plainly and once.]

[Signature] · [Date]

A worked example

My name is Renata Okoye. I have run a two-chair barbershop on Delancey Street for nine years. I know the names of my customers' kids.

On the night of March 14th I was closing. A man came in behind me while the door was still unlocked, put a knife against my back, and told me to open the register. He took $340 and my phone. He was in the shop for about ninety seconds. I was not physically hurt.

That is the part I have the hardest time explaining. Nothing happened to my body. And yet I have not closed that shop alone one single time since. My son drives across town four nights a week to sit in the back and read on his phone until I am done. He has a job of his own. He is tired. I have not asked him to stop because I have not been able to make myself close alone, and I have tried, twice.

I sleep about four hours. I have been seeing a counselor since May, once a week, $40 a visit after insurance. She thinks I will need about another year.

I lost eleven days of work — six for the injuries I did not have, which is to say six days I could not make myself go in, and five for court dates. My regulars have been patient. Two of them stopped coming.

What I want the court to know is that ninety seconds took something from me that I have not been able to get back, and it did it without leaving a mark. I am not asking for anything except that whatever happens here, I be told when he gets out.

— Renata Okoye

Why that one works. It is under 350 words. It is specific — Delancey Street, $40 a visit, four nights a week, two regulars. It does not characterize the defendant. It does not describe uncharged conduct. It ends with a request the court can actually grant. And it names the thing that is hardest to prove and most true: that harm without an injury is still harm.

Template 5 — Compensation application cover letter

Attach to the state compensation application. The application form is the substance; this letter tells the analyst how to read the file.

RE: Application for crime victim compensation — [Applicant name]

Enclosed is my application for victim compensation, with supporting documentation organized as follows:

Tab A — Police report [number], [agency], reported [date]

Tab B — Medical bills, itemized, with explanations of benefits showing amounts not covered

Tab C — Mental health treatment invoices and a provider letter regarding continuing care

Tab D — Wage documentation: pay stubs for the eight weeks before and after, and an employer letter

Tab E — Funeral invoice, itemized (if applicable)

Tab F — Relocation and security expenses

Insurance. My health insurer paid $______ and denied $______. The denial letters are behind Tab B. I understand the program is a payer of last resort and have submitted all available coverage first.

Reporting. I reported to law enforcement on [date], which is [within / outside] the standard window. [If outside:] I am requesting a good cause exception because [reason — fear of the offender, ongoing relationship, age, medical incapacity, a forensic medical examination completed on [date] in lieu of a report]. Documentation of that circumstance is behind Tab G.

Continuing losses. Treatment is ongoing. I understand I may file supplemental claims and intend to do so as costs are incurred.

Please contact me at [phone] or [email] if any part of the file is incomplete. I would rather send you a missing document than receive a denial.

[Signature] · [Date]

Note. That last line is not decoration. Analysts deny incomplete files because the file is incomplete, not because the claim is bad. An explicit invitation to ask for more is worth sending.

Template 6 — Appeal of a compensation denial

Appeals are free, informal, and reversed more often than people expect. Almost every denial is about documentation, eligibility criteria, or a deadline — and each of those has an answer.

RE: Appeal of denial — Claim No. [XXXX], [Applicant name]

I am appealing the denial dated [date]. The stated reason was: "[quote the denial language exactly]."

Response.

[Choose the one that fits.]

— If denied for late reporting: I did not report within [N] days because [specific reason]. [State law / program rules] permit a good cause exception in these circumstances. Enclosed is [a protective order, a medical record, a counselor's letter, a forensic examination report, documentation of my age at the time] establishing that circumstance.

— If denied for insufficient documentation: Enclosed are the documents the denial identified as missing: [list]. [If a document does not exist, say so and explain: "The urgent care clinic closed in 2025; enclosed is my insurer's claim history showing the visit and the amount billed."]

— If denied for non-cooperation: I did cooperate. Enclosed is [a letter from Detective ____, my subpoena and appearance record, correspondence with the prosecutor's office]. [If cooperation was limited: "I did not attend the interview scheduled for [date] because [reason]. I contacted [name] on [date] to reschedule; the record of that contact is enclosed."]

— If denied for contributory conduct: [State the facts plainly, without argument. "The report describes a mutual altercation. Enclosed is the responding officer's supplemental report identifying me as the party who withdrew, and the charging decision reflecting that no charges were filed against me."]

— If denied because no one was charged: My understanding is that a charge or conviction is not required for eligibility; the requirement is that the crime was reported and that I cooperated. Both are documented above.

I request reconsideration on the enclosed record and, if the denial is maintained, a hearing.

[Signature] · [Date]

Template 7 — Evidence preservation letter

Send this within days, not weeks. Surveillance systems overwrite in 7 to 30 days. This letter is for the civil side of the case, and it is the single highest-value thing an individual can do without a lawyer.

RE: Preservation of evidence — incident of [date] at [address]

To [property owner / management company / business]:

On [date] at approximately [time], I was the victim of a crime at [location]. [One sentence describing what happened.] I anticipate litigation arising from this incident.

You are requested to preserve, and not to alter, delete, overwrite, or destroy, the following:

All video surveillance from [date range], from every camera with any view of [specific locations: the north entrance, the parking area, the stairwell, the loading dock], including footage before and after the incident.

Access control and key card records for [date range].

Incident reports, security logs, and guard tour records for [date range].

Records of prior criminal incidents, police calls, or security complaints at this property for the preceding [three] years.

Lighting maintenance and repair records for the area.

Security personnel schedules and staffing records for [date].

Contracts with any security vendor in effect on [date].

All communications regarding this incident.

Please confirm in writing within ten days that these materials have been preserved. If any category has already been lost or overwritten, identify it, state when, and state why.

[Signature] · [Date] [Copy: your insurer, your attorney if you have one]

Note. Specificity is what makes this work. "Preserve all relevant evidence" is easy to ignore. "Camera 4, north entrance, March 14, 8:00 p.m. to 10:00 p.m." is not.

Template 8 — Employer notice letter

Give this to a supervisor or HR in advance, with the subpoena attached. Many states protect time off for victims; the protection generally depends on giving notice.

RE: Court appearance — [dates]

[Supervisor / HR]:

I am the victim in a criminal case that is being prosecuted by the [County] District Attorney. I am required to appear in court on the following dates: [list].

A copy of the subpoena is attached. [Or: a letter from the victim-witness unit confirming my required appearance is attached.]

I understand [State] law provides protection for employees who must attend criminal proceedings as a victim or witness. I will give as much advance notice as I receive; court dates are frequently continued on short notice, and I will inform you immediately when they change.

I would appreciate keeping this matter confidential within the organization.

[Signature] · [Date]

Template 9 — Parole and release input letter

Sent to the parole board or corrections department when release is being considered. This is often years after sentencing — which is exactly why the notification registration in Template 1 matters.

RE: [Inmate name], [DOC number] — victim input regarding release

I am the victim in [case number], for which [inmate] is serving a sentence. I am submitting input regarding the pending release consideration.

The offense and its continuing effect. [Two or three paragraphs. What happened, and where you are now — years later. Be concrete about what has and has not resolved.]

Conditions I am requesting, if release is granted:

A no-contact condition covering me and [named family members], including contact through third parties, mail, telephone, and electronic or social media communication.

A geographic exclusion from [town / a radius around my home and workplace / the county].

Notification to me in advance of release, and of any subsequent change in supervision status or residence within [county].

Continued restitution payment as a condition of supervision, with the balance of $______ remaining as of [date].

[Any condition specific to your case: no contact with minors, treatment participation, no employment in a particular setting.]

I [do / do not] wish to appear at the hearing. I [do / do not] consent to this statement being shared with the inmate.

[Signature] · [Date]

Note. The consent question at the end is real and you should answer it deliberately. Ask the advocate what happens in your state — in some, a statement shared with the inmate carries more weight; in others, a confidential statement is standard. Do not leave it blank.

A short list of things worth doing that are not letters

Ask for the advocate's direct line and use it. The system communicates when asked and rarely otherwise.
Keep one folder, physical or digital, and put everything in it. Two years from now, the parole letter will need the case number, the DOC number, and the restitution balance, and you will not remember any of them.
Photograph before you repair. The instinct to fix the door and clean the room is correct and it destroys the record.
Call the civil lawyer while the criminal case is pending. The limitations clock runs on its own schedule.
Re-register annually. Offices reorganize, systems migrate, and addresses go stale.