Ofce of Arizona Attorney General
Mark Brnovich
2005 N Central Avenue, Phoenix, AZ 85004
Victim Rights Complaint
Please complete the form as completely as possible. For questions regarding the form or victims’
rights, contact the Office of Victim Services or the Sate Victims’ Rights Administrator for Compliance at
(602)542-4911. Para asistencia en español, por favor llame al 602-542-4911.
Date received: Case Number:
Your Information Agency(s) of Complaint
Name:
Name:
Address:
Staff
Involved:
City:
State:
Zip:
Phone(s):
Phone:
Complaint Information:
County: City:
Have you addressed this matter with the agency or staff involved? (Yes or No)
Is there an ongoing criminal case or investigation or investigation? (Yes or No)
If so, what are you case numbers, if known?
Police Report Number(s):
Court Report Number(s):
What is the defendant’s name?
What is the date of the crime(s)?
How would you like the Ofce of Victim Services to help you?
