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Douglas County District Attorney Victim/Witness Services 1313 Belknap Street Room #203 Superior, Wisconsin 54880 Phone # (715) 395-1349 Fax # (715) 395-1481 Victim Request Form YOUR NAME: Wisconsin law provides crime victims a number of rights. You may choose to assert some, all, or none of these rights. Please check the rights you wish to assert and return this completed form to the address below. I want to speak with the prosecutor about possible outcomes of the prosecution including potential plea agreements and Sentencing, Consent Decree, or Dispositional recommendations. I want to request restitution for medical expense, damaged or lost property lost wages or other losses resulting from the crime committed against you (Restitution Request Form Enclosed). I want to receive notice of the date, time, and place of all court hearings in this case. (Note; you will receive notice of any hearing where your testimony is required regardless of whether you choose to exercise this right) I want to be present in the courtroom at the time of the Sentencing, Juvenile Consent Decree, or Dispositional Hearing. I want to make a statement in person to the Judge at the time of the Sentencing, Juvenile Consent Decree, or Dispositional Hearing. I want to receive written information about the final disposition of the case. Please print your E-Mail Check this box if you prefer to receive notices by E-Mail rather than U.S. Mail Please return this request form to : Victim/Witness Assistance Services Douglas County District Attorney Office 1313 Belknap Street Room #203 Superior, Wisconsin 54880