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Advocate First Name
*
Advocate Last Name
*
Advocate Agency Email
*
*
Organization Type
Office of the Attorney General
Virginia Parole Board
VA Department of Corrections
Local Victim/Witness Program
Other
Victim Information
First Name
*
Email
*
Address Line 1
*
Middle Name
*
Phone 1
*
Address Line 2
*
Last Name
*
Phone 1 Type
Landline
Mobile
TTY/TDD
City
*
Suffix (jr., III, etc.)
*
Phone 2
*
State
*
Sex
Female
Male
Other
Unknown
Phone 2 Type
Landline
Mobile
TTY/TDD
Zip
*
Date of Birth
*
PIN
*
Zip Code
20101
20102
20103
20104
20105
20106
20108
20109
20110
20111
20112
20113
20115
20116
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20118
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Preferred Language
Thai - Thailand
Ukrainian - Ukraine
Chinese - China
Portuguese - Portugal
Dutch - Netherlands
Danish - Denmark
Romanian - Romania
Catalan - Catalan
Japanese - Japan
English
Finnish - Finland
Latvian - Latvia
Kazakh - Kazakhstan
Spanish (Traditional Sort) - Spain
French - France
Basque - Basque
Italian - Italy
Swedish - Sweden
Galician - Spain
Polish - Poland
Croatian - Croatia
Hindi - India
Serbian (Latin) - Serbia
Serbian (Cyrillic) - Serbia
Korean - Korea
Czech - Czech Republic
Estonian - Estonia
Indonesian - Indonesia
Portuguese - Brazil
Bulgarian - Bulgaria
Russian - Russia
Slovenian - Slovenia
Lithuanian - Lithuania
Chinese - Hong Kong SAR
Hungarian - Hungary
Vietnamese - Vietnam
Chinese - Traditional
Greek - Greece
German - Germany
Norwegian (Bokmål) - Norway
Turkish - Turkey
Slovak - Slovakia
Malay - Malaysia
Federal Case
Federal Case
No
Federal Case
Yes
Incident Details
What is your relationship to the victim?
*
Ex-spouse/partner
Child in common
Spouse/partner
Child
Parent
Step-parent
Step-child
Sibling
Aunt
Uncle
Cousin
Grandparent
Friend
Business
Neighbor
Caregiver of children
Other family
Victim/Self
Witness
None
Unknown
Where did the offense occur?
Accomack
Albemarle
Alexandria City
Alleghany
Amelia
Amherst
Appomattox
Arlington
Augusta
Bath
Bedford
Bedford City
Bland
Botetourt
Bristol City
Brunswick
Buchanan
Buckingham
Buena Vista City
Campbell
Caroline
Carroll
Charles City
Charlotte
Charlottesville City
Chesapeake City
Chesterfield
Clarke
Clifton Forge
Colonial Heights City
Covington City
Craig
Culpeper
Cumberland
Danville City
Dickenson
Dinwiddie
Emporia City
Essex
Fairfax
Fairfax City
Falls Church City
Fauquier
Floyd
Fluvanna
Franklin
Franklin City
Frederick
Fredericksburg City
Galax City
Giles
Gloucester
Goochland
Grayson
Greene
Greensville
Halifax
Hampton City
Hanover
Harrisonburg City
Henrico
Henry
Highland
Hopewell City
Isle Of Wight
James City
King And Queen
King George
King William
Lancaster
Lee
Lexington City
Loudoun
Louisa
Lunenburg
Lynchburg City
Madison
Manassas City
Manassas Park City
Martinsville City
Mathews
Mecklenburg
Middlesex
Montgomery
Nelson
New Kent
Newport News City
Norfolk City
Northampton
Northumberland
Norton City
Nottoway
Orange
Out of State
Page
Patrick
Petersburg City
Pittsylvania
Poquoson City
Portsmouth City
Powhatan
Prince Edward
Prince George
Prince William
Pulaski
Radford
Rappahannock
Richmond
Richmond City
Roanoke
Roanoke City
Rockbridge
Rockingham
Russell
Salem
Scott
Shenandoah
Smyth
South Boston
Southampton
Spotsylvania
Stafford
Staunton City
Suffolk City
Surry
Sussex
Tazewell
Unknown
Virginia Beach City
Warren
Washington
Waynesboro City
Westmoreland
Williamsburg City
Winchester City
Wise
Wythe
York
What are the Circuit Court Case Numbers? (if known)
*
Date of Sentence
*
Length of Sentence
*
Inmate
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Comments
*
Terms and Conditions
Agree to Terms and Conditions
Agree to Terms and Conditions
No
Agree to Terms and Conditions
Yes