Brochure-Form

Include a tear-off form for the officer with the following information:

Date of Incident
Incident
Case Number
Case Officer
Court Date
Under the provisions of State Statute 16-3-1515, a victim or witness who wishes to exercise his or her rights under this article or receive services under this article or both must provide a law enforcement agency, a prosecuting agency, a summary court judge, the Department of Corrections, the Department of Probation, Parole, and Pardon Services, the Board of Juvenile Parole, or the Department of Juvenile Justice, as appropriate, his legal name, current mailing address, and current telephone number.
Legal Name
Current Mailing Address
Current Telephone Number
Secondary Telephone Number
Signed: "I hereby acknowledge that the reporting officer in this case has advised me of my rights as a victim in this matter.
--Signature of Victim
--Signature of Officer
Blank space for Officer remarks
Yes/No if Victim or Witness requests further assistance
Include a Victim and Witness Rights Notification Checklist:
- Provide victim or witness a copy of the Victim and Witness Rights Brochure.
- Provide victim or witness with case information on the brochure.
- Complete the Victim or Witness legal name, current address, and telephone number.
- Provide the Beaufort County Detention Center with the victim or or witness legal name, current address, telephone number.
- Attach this form to the incident report.
- Reviewed by the Victim Assistance Office.
Upon the completion of this form it is removed from the brochure and retained by the officer. The information contained therein is then passed along to the appropriate agencies.