VICTIM STATEMENT
I _____________________________________________HEREBY MAKE THIS
VOLUNTARY STATEMENT TO THE CLARK COUNTY JUVENILE COURT.
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DATE OF BIRTH_______________________
SOCIAL SECURITY NUMBER _____________________________
PHONE-HOME___________________________ CELL ______________________
WORK______________________________________
ADDRESS ___________________________________________________________
SIGNATURE ___________________________DATE:________________________
SUSPECT INFORMATION
The information requested below is required prior to the filing of the Complaint at
the Clark County Juvenile Court.
NAME __________________________________________________________
ADDRESS _______________________________________________________
CITY ___________________________________________________________
STATE __________________________________________________________
ZIP ______________________
Suspect’s Age/or Date of Birth ________________________________________
Suspect’s Parent’s Name ______________________________________________
Suspect’s Sex and Race _______________________________________________
Suspect’s Telephone Number __________________________________________
WITNESSES
WITNESS_________________________ ADDRESS__________________________________
CITY _____________________________ STATE___________ ZIP________________________
HOME PHONE _________________WORK PHONE_________________CELL_____________
DATE OF BIRTH____________________ SOCIAL SECURITY NUMBER_________________
AGE_______ RACE_____________SEX_____ MARITAL STATUS _____________________
RELATIONSHIP TO SUSPECT ____________________________________________________
RELATIONSHIP TO VICTIM _____________________________________________________
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WITNESS_________________________ ADDRESS__________________________________
CITY _____________________________ STATE___________ ZIP________________________
HOME PHONE _________________WORK PHONE_________________CELL_____________
DATE OF BIRTH____________________ SOCIAL SECURITY NUMBER_________________
AGE_______ RACE_____________SEX_____ MARITAL STATUS _____________________
RELATIONSHIP TO SUSPECT ____________________________________________________
RELATIONSHIP TO VICTIM _____________________________________________________
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WITNESS_________________________ ADDRESS__________________________________
CITY _____________________________ STATE___________ ZIP________________________
HOME PHONE _________________WORK PHONE_________________CELL_____________
DATE OF BIRTH____________________ SOCIAL SECURITY NUMBER_________________
AGE_______ RACE_____________SEX_____ MARITAL STATUS _____________________
RELATIONSHIP TO SUSPECT ____________________________________________________
RELATIONSHIP TO VICTIM _____________________________________________________
WITNESS STATEMENT
I ___________________________________________ HEREBY MAKE THIS VOLUNTARY
STATEMENT TO THE CLARK COUNTY JUVENILE COURT.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
DATE OF BIRTH________________ SOCIAL SECURITY NUMBER ___________________
PHONES-HOME __________________WORK________________CELL__________________
ADDRESS____________________________________________________________________
CITY _______________________________STATE____________ZIP____________________
SIGNATURE __________________________________________________
WITNESS STATEMENT
I ___________________________________________ HEREBY MAKE THIS VOLUNTARY
STATEMENT TO THE CLARK COUNTY JUVENILE COURT.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
DATE OF BIRTH________________ SOCIAL SECURITY NUMBER ___________________
PHONES-HOME __________________WORK________________CELL__________________
ADDRESS____________________________________________________________________
CITY _______________________________STATE____________ZIP____________________
SIGNATURE __________________________________________________
WITNESS STATEMENT
I ___________________________________________ HEREBY MAKE THIS VOLUNTARY
STATEMENT TO THE CLARK COUNTY JUVENILE COURT.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
DATE OF BIRTH________________ SOCIAL SECURITY NUMBER ___________________
PHONES-HOME __________________WORK________________CELL__________________
ADDRESS____________________________________________________________________
CITY _______________________________STATE____________ZIP____________________
SIGNATURE __________________________________________________
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