Victims Restituition Request

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Please correct the field(s) marked in red below:

If you are a victim of a crime where criminal charges have been taken against an individual(s) and you are requesting restitution for this offense(s), please complete the following information. Submit the form by clicking the “submit” button at the bottom of this page.  This information will be attached to the criminal case pending in Smyrna General Sessions Court. Please bring any documentation of estimates or payments when you come to court. 
1
Victim's Name
 *
2
Address
 *
3
Daytime Phone Number
4
Evening Phone Number
5
E-mail Address
6
Smyrna Police Department Case Number
7
Smyrna General Sessions Case Number
8
Defendant's Name
9
Describe all the damages you have paid
 *
10
List all damages paid by others (third-party, insurance, etc)
11
List any other elements of damage for which your are seeking restitution
  1. To receive a copy of your submission, please fill out your email address below and submit.
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