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DO NOT MAIL THE COMPLETED FORM TO A (California)

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  • 13 check-boxes
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Page 1 of 2
MO DAY YEAR
STATE OF CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION
REQUEST FOR VICTIM SERVICES
CDCR 1707 (Rev. 06/16)
Office of Victim and Survivor Rights and Services (OVSRS)
P.O. Box 942883, Sacramento, CA 94283-0001
Toll Free Number: 1-877-256-6877 Fax Number: (916) 445-3737
Web
: http://www.cdcr.ca.gov/victims Email: victimservices@cdcr.ca.gov
DO NOT MAIL THE COMPLETED FORM TO A PRISON. ALL INFORMATION WILL REMAIN CONFIDENTIAL.
Check one: New/Revised Request for Victim Services Change of address/phone/e-mail only (complete sections A, D and E)
Collection of court ordered restitution only/no notification services (complete sections A, D and E)
S
ECTION A. APPLICANT INFORMATION (Must be completed.)
Witness who testified against the offender
Family member of victim, indicate relationship:___________________________________________________
(See page 2 – Section A)
Check one: Victim of crime(s) committed by offender
Name of Victim(s):
___________________________________________________
_____________________________________
Person requesting information
.______________________________________________________________________________
(FIRST) (MIDDLE) (LAST)
Physical Address: ____
(STREET) (CITY) (STATE) (ZIP CODE)
Mailing Address (If different): ____
(STREET) (CITY) (STATE) (ZIP CODE)
Telephone: (_____)____________________(_____)_______________________ _____________________________________
(PRIMARY) (SECONDARY) (E-MAIL)
N
OTE: It is your responsibility to keep the OVSRS informed of any changes to your contact information.
S
ECTION B. NOTIFICATION OF CHANGES TO OFFENDER’S CUSTODY STATUS (Complete if you want to request notification.)
To be notified of changes to the custody status of an offender, check the box below to indicate your preferred method* of
receiving notices:
1.
Send me notification by electronic mail (e-mail)
OR
2. Send me notification by mail
Please choose only one (1) mail delivery method:
Regular Mail Certified Mail (signature required to receive)
Change in custody status includes release,
death, escape, parole suitability hearing
(Victims/Victims’ family members only),
contract, or scheduled execution.
NOTE: CDCR is unable to provide notification
each time an offender is transferred between
institutions.
* NOTE: If the preferred method of notification you selected is not available, regular mail will be used to send the notice.
S
ECTION C. CONDITIONS OF PAROLE/COMMUNITY SUPERVISION (Complete if you want to request special conditions.)
Requests for special conditions of parole/community supervision are considered but not guaranteed.
I request the following conditions when the offender is released on parole/community supervision:
1.
Offender not be allowed to contact me while he/she is on parole/community supervision.
2. Offender not be allowed to live in the same county that I live in.
For direct victims/witnesses only:
3. Offender not be allowed to live within 35 miles of my home address
(available only for specific types of crimes, see page 2)
N
OTE: If you would like to provide additional information explaining your request, attach a separate sheet of paper.
S
ECTION D. OFFENDER IDENTIFICATION (Complete as much information as possible.)
Offender’s Full Name (Print):
(FIRST) (MIDDLE) (LAST)
Date of Birth:
MO DAY YEAR
CDCR Number (Offender ID): Date Sentenced to Prison:
Court Case Number: County of Sentencing:
S
ECTION E. APPLICANT SIGNATURE (Sign and date the completed form.)
Signature of Applicant:
_____________________________________
_________________
Date:_______________________
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Page 2 of 2
DEPARTMENT OF CORRECTIONS AND REHABILITATION
STATE OF CALIFORNIA
REQUEST FOR VICTIM SERVICES
CDCR 1707 (Rev. 06/16)
I NS TR UC TI ONS
Read the following instructions carefully to fill out page 1 of the form so that it can be processed correctly. Sections A, D, and E
must be completed. Complete all other sections, based on your needs. All information will remain confidential.
Check one of the three boxes at the top of the CDCR 1707 form to indicate if this is a new/revised request for victim services, a
change of address/phone/e-mail only, or Collection of court ordered restitution only/no notification services. If you check
change of address/phone/e-mail only, complete sections A, D, and E. If you check Collection of court ordered restitution
only/no notification services, complete sections A, D, and E.
SECTION A. APPLICANT INFORMATION
S
ECTION C. CONDITIONS OF PAROLE/COMMUNITY SUPERVISION
This section must be completed. Check the box that most
accurately describes your relationship to the crime: victim,
witness, or family member of victim and your relationship to
the victim. (Example - spouse, child, sibling, grandparent or
grandchild)
Please indicate the name(s) of the victim(s) of the crime
committed by the offender.
Clearly print your name, physical address, mailing address (if
different), your primary phone number, secondary phone
number, and e-mail address.
N
OTE: In order to be entitled to receive notice the requesting
party shall keep the department or board informed of his or her
current contact information.(Penal Code sections 3043(a)(1),
3058.8(b)
S
ECTION B. NOTIFICATION OF CHANGES TO OFFENDER’S CUSTODY
STATUS
Complete this section if you choose to request notification
services. Check the most appropriate box(es).
You have one of two choices to receive notice of an offender’s
release, escape, death, parole suitability hearing
(Victims/Victims
’ family members only), contract, or scheduled
execution.
Check Box 1 to register to receive notification by electronic mail
(e-mail).
Check Box 2 to register to receive notification by mail.
Indicate
whether you prefer to receive your notice by regular mail or
certified mail. If the preferred method of notification you selected
is not available regular mail will be used to send the notice.
N
OTE: It is your responsibility to request notification of an
offender’s criminal appeal. Please call the State of California,
Office of the Attorney General, Victim Services Unit
1-877-433-9069.
Complete this section if you choose to request special
conditions of parole/community supervision. You may check all
the conditions that you w
ish to request or are eligible to receive
however such conditions are not guaranteed.
Checking Box 1 will request that the offender have no contact
with you while he/she is on parole/community supervision.
Checking Box 2 will request that the offender not be allowed
to live in the same county that you live in.
Checking Box 3 will request that the offender not be allowed
to live within 35 miles of your home address. Per Penal
Code Section 3003, available only for the following crimes:
murder or voluntary manslaughter, mayhem, rape, sodomy by
force, oral copulation, lewd acts on a child under 14, any felony
punishable by death or imprisonment in the state prison for life,
stalking, felony with a great bodily injury enhancement, and
continuous sexual abuse of a child.
N
OTE: The third box applies to direct victims and witnesses
only. (Penal Code section 3003)
S
ECTION D. OFFENDER IDENTIFICATION
Provide as much information as you can in this section to
ensure that we have the correct offender involved in your case.
If you need help completing this section, you may contact the
district attorney’s office in the county where the trial was held.
S
ECTION E. APPLICANT SIGNATURE
Sign and date the completed form.
SUBMIT COMPLETED FORM BY MAIL, FAX OR E-M A IL (SCANN ED COPY) TO:
California Department of Corrections and Rehabilitation
Office of Victim and Survivor Rights and Services
P.O. Box 942883, Sacramento, CA 94283-0001
Fax: (916) 445-3737 / E-mail: victimservices@cdcr.ca.gov
PRIVACY STATEMENT:
AGENCY STATEMENT: The California Department of Corrections and Rehabilitation (CDCR), CDCR 1707, Request for Victim Services. OFFICE
RESPONSIBLE FOR FORM: Office of Victim and Survivor Rights and Services, P.O. Box 942883, Sacramento, CA 94283-0001. The telephone number is
1-877-256-6877. AUTHORITY: California Constitution Article I, section 28, Penal Code sections 667.5, 679.03, 2085.5, 3003, 3043, 3058.8, 3605,
5065.5.
PROVIDING INFORMATION: The information requested is necessary to process your request for victim services and is voluntary. Failure to provide any
of the information requested may prevent the OVSRS from processing your request. All information will remain confidential per Penal Code section
679.03(c): Your information may be shared with the investigating agency, the district attorney’s office that prosecuted the case, and/or the State of
California, Office of the Attorney General, Victim Services Unit.
Penal Code section 5065.5: When notified that an offender has entered into a contract for the sale of the story of a crime for which the offender was
convicted CDCR will notify registered victims and victim’s immediate family members.
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DO NOT MAIL THE COMPLETED FORM TO A (California)

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Completed 20 April 2022

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