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Crime Victims Notification Form

If you have a case pending before the MS Court of Appeals or the Supreme Court and would like to be notified by this office of any decision made on your case, please register below. Please make sure that your information is current and correct.

Name of Victim*

Victim's Representative Name (if any)

Street Address*

Street Address (cont'd)

Street Address (cont'd)

City*

State*

Zip Code*

Home Phone*

Work Phone

Cell Phone

Email*

Name of Offender*

County of Crime*

Enter in any special notes here.

Please enter the word you see in the image below: *

* - fields marked with the asterisk are required.