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Probation
Victim Impact Panel Registration form
First Name (Nombre):
*
Last Name (Apellido):
*
Date of Birth (Fecha de nacimiento):
*
Address 1 (Dirección 1):
*
Address 2 (Dirección 2):
City (Ciudad):
*
State (Estado):
*
NY - New York
AK - Alaska
AL - Alabama
AR - Arkansas
AZ - Arizona
CA - California
CO - Colorado
CT - Connecticut
DE - Delaware
FL - Florida
GA - Georgia
HI - Hawaii
IA - Iowa
ID - Idaho
IL - Illinois
IN - Indiana
KS - Kansas
KY - Kentucky
LA - Louisiana
MA - Massachusetts
MD - Maryland
ME - Maine
MI - Michigan
MN - Minnesota
MO - Missouri
MS - Mississippi
MT - Montana
NC - North Carolina
ND - North Dakota
NE - Nebraska
NH - New Hampshire
NJ - New Jersey
NM - New Mexico
NV - Nevada
NY - New York
OH - Ohio
OK - Oklahoma
OR - Oregon
PA - Pennsylvania
RI - Rhode Island
SC - South Carolina
SD - South Dakota
TN - Tennessee
TX - Texas
UT - Utah
VA - Virginia
VT - Vermont
WA - Washington
WI - Wisconsin
WV - West Virginia
WY - Wyoming
DC - District of Columbia
GU - Guam
PR - Puerto Rico
AS - American Samoa
MP - Northern Mariana Islands
VI - U.S. Virgin Islands
Zip Code (Código postal):
*
Phone Number (Número de teléfono):
*
Email Address (Dirección de correo electrónico):
*
Language Preference (Idioma preferido):
*
Please Select...
English
Spanish
Are you on probation?
*
(¿estás en libertad condicional?)
Please Select...
Yes
No
If Yes, who is your probation officer?
*
(Si es así, ¿quién es su oficial de libertad condicional?)
Please Select...
Acampado
Ackerman
Alicea
Anderson
Andre
Arnold
Arroyo
Bardales
Basnight
Blalock, J
Bluth
Bonilla
Bufalo
Bullock
Cangero
Cardarelli
Castano
Castillo
Ciminelli
Coleman
Connan
Constain
Dammes
Delossantos
DeStefani
Dimartino
Ditomasso
Duplessis
Egner
Elia
Eschmann
Esposito
Feehan
Fernandez
Ferraro
Fiorvanti
Fischer
Fisher
Gerken
Gleason
Gomez, J
Gomez, R
Greaney
Grommeck
Hammond
Henderson
Hoare
I DON'T KNOW
Jackson
Jenkins
John
Johnson
Johnstone
Jones
Kettrick
L'Hommedieu
Lewis
Lewis
Liferiedge
Marcellus
Marino
Martinez
Martino
Mays
McClernon
Mcqueen
Moder
Monrose
Moore
Morris
Moussa
Muller
Mullervy
Murray
Noble
O'Hanlon
Olson
Orr
Pacca
Palmese
Papatsos
Pereira
Perez, G.
Perez, T
Perrone
Phinn
Pinto
Przywara
Quinones
Rechner
Reilly
Reyes
Rivera
Rivezzo
Rodriguez
Roge
Rohde
Romero
Russell
Russo
Sabella
Salem
Santoiemma
Scalera
Schatzle
Shannon
Smith
Smith
Southerland
Sweet
Thomas
Torby
Torres, B
Torres, M
Turner
Tyson
Vazquez
Villacis
Washington
White
Wilson
Windham
Winston
Wolfolk
Zuniga
Probation Cases number (if known)
Número de caso (si se conoce):
All fields marked with a red asterisk (
*
) are required
Submit