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Basic Submission Information

2. Per Ohio Revised Code 149.43 this document is not a public record.

4. Type of Form*

   1. Initial
   2. Updated
5. Form Completed By:*

   1. Victim
   2. Law Enforcement
   3. Prosecutor
6. Submitted
   Submitted

   Submitted
10. Police Report#
11. Municipal Case#
12. Common Pleas Case#
14. Reporting Agency & Phone Number*
    -- Select One --Williams County Sheriff's Office 419.636.3151Bryan Police Dept 419.633.6050Pioneer Police Dept 419.737.3129West Unity Police Dept 419.924.2271Edon Police Dept 419.272.3333Edgerton Police Dept 419.298.2343Ohio State Highway Patrol Post #20 419.784.1025Ohio State Highway Patrol Post #89 419.826.5871Stryker Police Dept 419.682.4911Corrections Center of Northwest Ohio 419.428.3800Montpelier Police Department 419.485.3121
16. Officer Name*
17. Badge#
19. Defendant's Name*
21. Arraignment or Initial Appearance
    Arraignment or Initial Appearance

    Arraignment or Initial Appearance
22. Location
    -- Select One --Bryan MunicipalWilliams County Common Pleas
24. Continue

Victim's Rights Election

2. Per Ohio Revised Code 149.43 this document is not a public record.

4. WILLIAMS COUNTY VICTIM'S RIGHTS ELECTION
6. RIGHTS THAT MUST BE REQUESTED

   Please select all that apply.

   1. I want my name, address, and identifying information to be redacted (removed) from law enforcement records
   2. I want my name, address, and identifying information to be redacted (removed) from prosecutor records
   3. I want my name, address, and identifying information to be redacted (removed) from court records
   4. I want notice of the arrest, escape, or release of the offender.
   5. I want reasonable and timely notice of all public proceedings.
   6. I want to confer with the prosecutor in the case.
   7. I want to be notified of subpoenas, motions, or other requests to access any of my personal information.
   8. I want to appoint a Victim's Representative.
   9. I want interpretation services during contacts with criminal justice system officials.
8. Interpretation Services Requested
10. Continue |Go Back

Victim Contact Information

2. Per Ohio Revised Code 149.43 this document is not a public record.

4. VICTIM CONTACT INFORMATION

   If you select to appoint a representative, please provide their contact information also.

6. First Name
7. Middle
8. Last Name
10. Contact Preference

    Please mark at least one

    1. Phone

    1. Email

    1. Mail

    1. Text
12. Phone Number
13. Alternate Phone
15. Email Address
16. Fax Number
18. Address 1
20. Address 2
22. City
23. State
24. Zip Code
26. Custodial Agency Notification

    1. Please provide my name and contact information, and that of my representative, if applicable, to the custodial agency, if any.
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Representative Contact Information

2. Per Ohio Revised Code 149.43 this document is not a public record.

4. Optional Notification for Representative

   1. As the victim, I do not wish to receive notices about this case. Please provide notices to my representative.
6. REPRESENTATIVE CONTACT INFORMATION
8. First Name
9. Middle
10. Last Name
12. Contact Preference

    Please mark at least one

    1. Phone

    1. Email

    1. Mail

    1. Text
14. Phone Number
15. Alternate Phone
17. Email Address
18. Fax Number
20. Address 1
22. Address 2
24. City
25. State
26. Zip Code
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit | Go Back

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