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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
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WI - Wisconsin
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WY - Wyoming
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...
I DON'T KNOW
Acampado
Albertson
Alicea
Alvarenga
Anderson
Andre
Arnold
Arroyo
Bardales
Basnight
Blalock, J
Blalock, L
Bluth
Bullock
Cangero
Capasso
Cardarelli
Castano
Castillo
Coleman
Connan
Constain
Dammes
Delossantos
DelValle
DeStefani
Dimartino
Duplessis
Egner
Elia
Esposito
Fanning
Feehan
Fernandez
Fiorvanti
Fischer
Fisher
Forte
Gerken
Gomez, J
Gomez, R
Greaney
Grommeck
Guardino
Hammond
Hart
Henderson
Hilliard
Hoare
Jackson
Jenkins
John
Johnson
Johnstone
Jones
Kettrick
Lewis
Lewis
Liferiedge
Marino
Martinez
Mays
McClernon
Mcqueen
Mintz
Monrose
Moore
Moussa
Muller
Mullervy
Murray
Noble
O'Hanlon
Olson
Orr
Pacca
Papadimitriou
Papatsos
Pereira
Perez, G.
Perez, T
Perrone
Phinn
Pinto
Quinones
Rechner
Reilly
Reyes
Rivera
Rivezzo
Rodriguez
Roge
Romero
Russell
Russo
Sabella
Salem
Santoiemma
Scalera
Schatzle
Shannon
Smith
Smith
Torby
Torres, B
Torres, M
Turner
Tyson
Vandewater
Vazquez
Villacis
Washington
White
Wilson
Windham
Wolfolk
Probation Cases number (if known)
Número de caso (si se conoce):
All fields marked with a red asterisk (
*
) are required
Submit