Victim Impact Form

City of Leawood Vs.*
Name Case No.
Today's Date*
MM slash DD slash YYYY
Victim's Name*
First Last
Address*
Street Address City State ZIP Code
Daytime Phone:*
Alternate Phone:
Email*
NOTIFICATION:
In order to ensure you receive updated information about this case, please contact Leawood Municipal Court at (913)339-6735 or court@leawood.org if the address or telephone number(s) on this form changes.
PLEASE DESCRIBE THE IMPACT THIS CRIME HAS HAD ON YOUR AND YOUR FAMILY. INCLUDE ANY DIRECT FINANCIAL LOSSES FOR WHICH YOU REQUEST RESTITUTION, INCLUDING DOCUMENTATION. (Please attach additional pages if needed.)*
PLEASE DESCRIBE THE IMPACT THIS CRIME HAS HAD ON YOUR AND YOUR FAMILY. INCLUDE ANY DIRECT FINANCIAL LOSSES FOR WHICH YOU REQUEST RESTITUTION, INCLUDING DOCUMENTATION. (Please attach additional pages if needed.)
COMMENTS ON SENTENCING:*
WHAT DO YOU FEEL WOULD BE AN APPROPRIATE PUNISHMENT? Include such considerations as psychological counseling, drug and/or alcohol treatment, community service, or no contact with you or others.
IF the Defendant is a first time offender, he or she may be eligible for Diversion. If Diversion is granted, the Defendant will be required to complete certain conditions set by the Prosecutor, which may include payment of restitution to you for your direct losses, and/or attend classes related to the offense. If the Defendant successfully completes the Diversion, the charge(s) will be dismissed. If the Defendant fails to successfully complete the terms and conditions of the Diversion, prosecution in this matter will be resumed.
IF the Defendant is a first time offender, he or she may be eligible for Diversion. If Diversion is granted, the Defendant will be required to complete certain conditions set by the Prosecutor, which may include payment of restitution to you for your direct losses, and/or attend classes related to the offense. If the Defendant successfully completes the Diversion, the charge(s) will be dismissed. If the Defendant fails to successfully complete the terms and conditions of the Diversion, prosecution in this matter will be resumed.
ARE YOU OPPOSED TO THE DIVERSION PROGRAM?
- No
- Yes
If yes, please explain why.
FUTURE NOTIFICATIONS - Check one:
- I DO NOT need to be notified of each public hearing or continuance.
- I DO want to be notified of each public hearing or continuance on this case.
Name
First Last
Date
MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.

Victim Impact Form

NOTIFICATION: