Complete those sections that apply, and add any additional sheets. This document may be completed by a friend, relative, or advocate for the victim. Write neatly or type.
Document/itemize financial losses, as a result of the crime. Sign and date the Victim Impact Statement form. Please return your statement to:
Victim Witness Assistance Program
Office of the Commonwealth's Attorney
9311 Lee Avenue, Suite 200 Manassas, VA 20110
Below is a list of suggestions for completing a Victim Impact Statement. Ask the victim/witness program staff or the prosecutor for more assistance in completing the form.
What you should do when completing the form:
What you should not do when completing the form:
Victim Impact Statement (VIS) Forms: