Victim Impact Statement

One of the most important rights you have as a victim is to let the Court know, prior to sentencing, how the crime has affected you and your family.  You may complete this form or mail, fax or email your statement to:

Mesa City Prosecutor’s Office
Victim Services
PO BOX 1466
Mesa AZ 85211-1466
Fax 480-644-2584


Full Name

Date of Birth

Last 4 digits of SSN

Docket Number

Mailing Address

Primary Phone

Primary Phone Type (cell, home, work, etc.)

Secondary Phone

Secondary Phone Type (cell, home, work, etc.)

Email Address

A Victim Impact Statement may include, but is not limited to the following:
1.       This is what the defendant did to me and/or my property
2.       This is how the crime has impacted me and/or my family
3.       This is how the crime affected my ability to earn a living
4.       This is the type of punishment the Court should impose on the defendant

 I consent to have my statement to be used for the purposes of sentencing and understand that copies may be made available to the court and the defendant and/or the defense attorney.

 I understand that this form  is intended solely for the use of crime victims to submit information to the Prosecutor’s Office, and that any person not authorized to provide information for the crime victim or anyone who knowingly submits information that is untruthful or false, may be subject to prosecution. I confirm that I am the person named above or have permission from the person named above to submit information on their behalf.