Form JD-VS-5 "Confidential Request for Notification of Status of Inmate" - Connecticut

What Is Form JD-VS-5?

This is a legal form that was released by the Connecticut Judicial Branch - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2017;
  • The latest edition provided by the Connecticut Judicial Branch;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form JD-VS-5 by clicking the link below or browse more documents and templates provided by the Connecticut Judicial Branch.

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Download Form JD-VS-5 "Confidential Request for Notification of Status of Inmate" - Connecticut

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CONFIDENTIAL REQUEST FOR
STATE OF CONNECTICUT
NOTIFICATION OF STATUS OF INMATE
OFFICE OF VICTIM SERVICES
JD-VS-5 Rev. 2-17
JUDICIAL BRANCH
C.G.S. §§ 18-81e, 54-228, 54-231
www.jud.ct.gov
Instructions
1. Complete as much of the information as you know.
2. You may send this form to the Office of Victim Services (OVS) or the Department
of Correction (DOC) or both at the addresses below.
3. If you have any questions, please call OVS at 1-800-822-8428 (toll-free nationwide)
or DOC at 1-888-869-7057 (toll-free statewide).
The Office of Victim Services (OVS) provides notification on inmates after sentencing and the Department of Correction
(DOC) provides notification on inmates before and after sentencing. You will be notified when an inmate applies for a change
in their custody status with the DOC and when an inmate is released or scheduled to be released from DOC custody. You will
receive confirmation that you have registered for notification and a brochure that explains the different types of notifications.
To: Office of Victim Services, 225 Spring Street, Wethersfield, CT 06109
To: Department of Correction - Victim Services Unit, 24 Wolcott Hill Road, Wethersfield, CT 06109
From (Your last, first name)
Daytime phone number
Evening phone number
Mailing address where notification letters should be sent (Number, street, apartment number, town and zip code)
Emergency contact person - In case you can't be reached (Give name and telephone number)
1. Would you like to receive notification from
DOC
OVS
Both - DOC and OVS
Your e-mail address
2. Please check if you prefer to receive notification by
standard mail
e-mail
3. If an inmate is scheduled to be released within 5 days and you have not received notification before from OVS about this
release, the OVS Helpline will send you a letter and call you. Do we have permission to leave a message on your
answering machine or voicemail?
Yes
No
4. Please check one box below that explains your relationship to the victim or inmate
Self
Parent/legal guardian
Legal representative
Deceased victim's immediate family member
How are you related to the victim? (example: brother)
State's Attorney
Inmate's immediate family member (OVS only)
How are you related to the inmate? (example: brother)
Name of inmate
DOC number (if known)
Docket number
Town where crime occurred
Arrest date
Sentencing date
Sentencing Court
I understand that it is my responsibility to notify the Office of Victim Services and the Department of Correction -
Victim Services Unit of any change in my mailing address, telephone number(s), or e-mail, if provided, so I can
continue to receive notification. I understand that my request for notification and contact information will be kept
strictly confidential and will not be shared by the Office of Victim Services or the Department of Correction.
Signature u
Date signed
ADA NOTICE
The Judicial Branch of the State of Connecticut complies with the Americans
with Disabilities Act (ADA). If you need a reasonable accommodation in
accordance with the ADA, contact the Office of Victim Services or the
Department of Correction - Victim Services Unit at the addresses shown above.
NOTICE: Keep a copy of this request for your records. If you do not receive confirmation that you are registered for
notification within 30 days, please call OVS at 1-800-822-8428 or DOC at 1-888-869-7057.
Print Form
Reset Form
CONFIDENTIAL REQUEST FOR
STATE OF CONNECTICUT
NOTIFICATION OF STATUS OF INMATE
OFFICE OF VICTIM SERVICES
JD-VS-5 Rev. 2-17
JUDICIAL BRANCH
C.G.S. §§ 18-81e, 54-228, 54-231
www.jud.ct.gov
Instructions
1. Complete as much of the information as you know.
2. You may send this form to the Office of Victim Services (OVS) or the Department
of Correction (DOC) or both at the addresses below.
3. If you have any questions, please call OVS at 1-800-822-8428 (toll-free nationwide)
or DOC at 1-888-869-7057 (toll-free statewide).
The Office of Victim Services (OVS) provides notification on inmates after sentencing and the Department of Correction
(DOC) provides notification on inmates before and after sentencing. You will be notified when an inmate applies for a change
in their custody status with the DOC and when an inmate is released or scheduled to be released from DOC custody. You will
receive confirmation that you have registered for notification and a brochure that explains the different types of notifications.
To: Office of Victim Services, 225 Spring Street, Wethersfield, CT 06109
To: Department of Correction - Victim Services Unit, 24 Wolcott Hill Road, Wethersfield, CT 06109
From (Your last, first name)
Daytime phone number
Evening phone number
Mailing address where notification letters should be sent (Number, street, apartment number, town and zip code)
Emergency contact person - In case you can't be reached (Give name and telephone number)
1. Would you like to receive notification from
DOC
OVS
Both - DOC and OVS
Your e-mail address
2. Please check if you prefer to receive notification by
standard mail
e-mail
3. If an inmate is scheduled to be released within 5 days and you have not received notification before from OVS about this
release, the OVS Helpline will send you a letter and call you. Do we have permission to leave a message on your
answering machine or voicemail?
Yes
No
4. Please check one box below that explains your relationship to the victim or inmate
Self
Parent/legal guardian
Legal representative
Deceased victim's immediate family member
How are you related to the victim? (example: brother)
State's Attorney
Inmate's immediate family member (OVS only)
How are you related to the inmate? (example: brother)
Name of inmate
DOC number (if known)
Docket number
Town where crime occurred
Arrest date
Sentencing date
Sentencing Court
I understand that it is my responsibility to notify the Office of Victim Services and the Department of Correction -
Victim Services Unit of any change in my mailing address, telephone number(s), or e-mail, if provided, so I can
continue to receive notification. I understand that my request for notification and contact information will be kept
strictly confidential and will not be shared by the Office of Victim Services or the Department of Correction.
Signature u
Date signed
ADA NOTICE
The Judicial Branch of the State of Connecticut complies with the Americans
with Disabilities Act (ADA). If you need a reasonable accommodation in
accordance with the ADA, contact the Office of Victim Services or the
Department of Correction - Victim Services Unit at the addresses shown above.
NOTICE: Keep a copy of this request for your records. If you do not receive confirmation that you are registered for
notification within 30 days, please call OVS at 1-800-822-8428 or DOC at 1-888-869-7057.
Print Form
Reset Form