HVFRA Submission Form

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Homicide Victims' Families' Rights Act Request

* Denotes a required field

Requestor's First Name

Requestor's Middle Name/Initial

Requestor's Last Name

Requestor's Suffix

Requestor's Mailing Address

Street

City

Country

Zip

Requestor's Email Address

Confirm

Requestor's Telephone Number

Relationship to Victim

Victim's First name

Victim's Middle Name/Initial

Victims Last Name

Victim's Suffix

Date of the Incident

Location of the Incident

Additional Details or Information