Victim Witness Forms


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

Helpful Hints

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:

  • Discuss how you felt while the crime was taking place or the emotional impact this crime has had on your life
  • Discuss the physical, psychological, and financial impacts of the crime
  • Use specific examples of how the crime has changed your life

What you should not do when completing the form:

  • Introduce new evidence not covered at the trial or repeat evidence already presented
  • Use derogatory or obscene language in discussing the defendant

Victim Impact Statement (VIS) Forms: