Adam Herold A Government VICTIM IMPACT Forcourtuse only of information Number Saskatchewan STATEMENT Vivim?r Nme/QdaeszlP?EQLCL _g1e/?a? r??raa?riee Service . Rem-r2__c_s_ ., . Offence Location QI Incident/File . . .- Trhis form may be used to provide a description of the physical or emotional harm, property damage or economic loss suffered by you as the result of the commission of an offence, as well as a description of the impact of the offence on you. You may attach additional pages if you need more space. Your statement?must not include: . any statement about the offence or the offender that is not relevant to the harm or loss you suffered; - any unproven allegations; . any comments about any offence for which the offender was not convicted; . any complaint about any individual, other than the o??ender, who was involved in the investigation or prosecution of the o??ence; or . - except with the court?s approval, an opinion or recommendation about the sentence. You may present a detailed account ofthe impact the offence has had on your life. The following sections are examples of information you may wish to include in your statement. You are not required to include all of this information. Emotional impact Describe how the offence has affected you emotionally. For example, think of: . your lifestyle and activities; a your relationships with others such as your spouse, family and friends; - your ability to work, attend school or study; and . your feelings, emotions and reactions as they relate to the offence. Physical impact Describe how the offence has affected you physically. For example, think of: - ongoing physical pain, discomfort, illness, scarring, disfigurement or physical limitations; 0 hospitalization or surgery you have had because of the offence; - treatment, physiotherapy or medication you have been prescribed; - the need for any further treatment or the expectation that you will receive further treatment; and - any pennanent or long-term disability. Economic impact Describe how the offence has affected you ?nancially. For example, think of: a. . the value 01 any property that was lost or damaged and the cost of repairs 0 replacement; and . ?nancial loss due to missed time from work; . the cost of any medical expenses, therapy or counselling; and . any costs or losses that are not covered by insurance. Please note that this is not an application for compensation or restitution. Fears for security Describe any fears you have for your security or that ol'your family and friends. For example, think of: . concerns with respect to contact with the ollender; and - concerns with respect to contact hem een the and members ol your family or close triends Drawing, poem or letter You may use this space to draw a picture or \H?ilt?: II poem or letter il~ it ill help you express the impact that the ott?ence has had on you. ?mild like to present my statement in court. in the best ol'my kiln? ledge. the contained in this statement is true. Datedthis LE .dayogl?mwij- 3? 19.. at? 1716311117 Signature of dcclarant It you completed this statement on hehalt ol the \ietun please indicate the reasons nhy you dId so and the nature ofyotu ,m Ielationsliip to the sictint. - . .- .. Dated this day 2t} .at . Signature of (leclarant What is a Victim Impact Statement? disclosure and is required by law. document. sentencing hearing. police-based victim services. I it is your opportunity to tell the court how this crime has affected you emotionally, physically and ?nancially. - it is important that the Judge knows how you have been banned, or suffered loss, as a result of this crime. 0 it is one of the factors the Judge may consider at the time of sentencing. What should I know before completing a Victim Impact Statement? - Your completed Victim impact Statement will be given to the person charged with the crime and hislher lawyer. This is called - it will be ?led with the court only after the accused person is found guilty- Once it is ?led with the court, it becomes a public I Others likely to see your Victim impact Statement include the Crown Prosecutor prior to sentencing, probation staff when supervising probation orders, and corrections staff when making decisions about the release of the offender Fromjail. . Please note: the law requires the Judge to consider only what is relevant to sentencing the offender. 0 You may be required to answer questions about your Victim impact Statement in court at a preliminary hearing, trial or How will my Victim Impact Statement be presented? - The Judge may read your Victim Impact Statement prior to sentencing. - You may read it out loud in court if you want, or present it in any other manner that the court approves of. If you are unable to provide a written statement in English or French, you should tell the police, the Crown Prosecutor or in some cases it is possible for a Victim impact Statement to be recorded and presented in a different way. What is Restitution? . it is money ordered by the court to be paid to a victim as part of an of l'cnder?s sentence. - it is to reimburse the victim for the actual loss or damage resulting from a crime. - It is one way the offender can make up for the harm you have experienced. .icstitution may cover: - Damage or loss to your property; - Financial loss due to ii?aud: - Financial loss or expenses due to physical injury; a The expenses of lcmporary housing. food, childcare, transportation or moving out of the offender?s household. when the harm is to the Spouse or child: and a Financial loss due to unknowingly buying stolen property that has been returned to its lawful on ncr. How do I request Restitution? - Complete the application on the inside of this brochure. - Clearly set out the amount of your loss/damages. - If you need help completing the form or in formation about the process. contact your local police-based victim services or the Crown Prosecutor. What happens next? it The Crown Prosecutor may use the application to request the Judge to order restitution. ll'an offender is convicted, the Judge may order restitution. but can do so only during sentencing. a probation olTIcer prepare a report about your loss. . You will receive restitution only il?thc Judge orders it paid to you and the complies. . Enquiries may be made through your local police-based victim scniccs or the crown prosecutor's oliicc. . Il?rcslitution is ordered. you will receive a letter ol'notilicution. - You may request a copy of the restitution order (from court). a You should then contact the Victim Services Restitution Program for information about the terms and next steps for collection (scc information on previous- page). - if not paid, you may have the restitution order entered as a civil court that is enforceable against the in the - Take whales or steps you feel are necessary to repair damages from the crime. . estimates, imoiccs or sales receipts for the cost of repairs, replacement and directly related costs. In deciding whether to order restitution, the Judge may ask that You may submit a Victim Impact Statement 91 a Statement on Restitution 31 both. police agency as quickly as possible. They must be received before the offender is sentenced so they can be considered by the Judge. if you know that the accused has an upcoming court appearance, you should return the completed Instruction for Submission: Return your completed Victim Impact Statement andlor Statement on Restitution to the investigating form(s) directly to the crown prosecutor?s of?ce. You may submit additions to your Victim Impact Statement andlor Statement on Restitution up to the date the offender is sentenced. i: I 3192333 Statement on Restltutlon A Saskatchewan my Mlniitry of, :2 Canada Province of Saskatchewan. To the court that is sentencingw (tmme tiffillc?litfc't') who was convicted, or was discharged under section 730 at the Criminal Code or an under that Au. 1, . (morn:ofdcdurrmr}. declare lltal (check appropriate but): Cl I am not seeking restitution for the losses and damages I suffered as the result of the commission ot'thc offence. (ii) i am seeking restitution in the amount of$ for the following losses and damages I suffered as a result ofthc commission of the offence. Description Amount of loss and (tonnage (describe t-?ut?h Instr and (arrange) (suite the tors and damnunderstand that the amount of my losses and damages must be readily ascertainable by the court. For that purpose, 1 am responsible for providing the court with all necessary documents, including bills, receipts and estimates, in support of my claim for restitution. 1th this day of 20 at Signature of rleclnrant incident Information: Location ofincident Date ofincident Name of investigating police agency and of?cer Police incident/tile number Please indicate whether victim is El Individual Business or agency lfa business or agency, provide your ?le number and/or contact person Mailing address: P.O. Box Street address City Province Postal Code Insurance Coverage: is the lossfdanulgc insured? UYes UNO amount ofinsurancc deductible Name and phone number of inaurance companytadjuster H912 iS availa . . . if you have been the victim ofa crime The Victims Services Program helps victims involved in the criminal justice system in Saskatchewan by providing programs and services. if you need help with your Victim impact Statement or Statement on Restitution, contact the police-based victim services program nearest you, or your local police service or RCMP detachment. For more information and a list of police-based victim services programs 11' you have questions after restitution go to or contact: has been ordered contact: Toll free: l-888-286~6664 Toll free: 1-888-286-6664 in Regina: 306-787?3500 in Regina: 306-787-0l73 Elnail: Email: did?1m Impac?f? S+a+emamf I: am Hdam Herald?s MamJ ?awena #er-omL Adam was 1L5. ~143qu 013 and ?m gauges? 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MP ?prl) 3:313 ?ick/47 ?ee April ALL Lilac/Prapm/ (9 590/8 of Information Number Saskatchewan .. 4 Ministry ofJustlce Victim?s Name Police Service ng?nf?w Offence Location incident/File Number am .r Government VICTIM IMPACT For courtuse only A This form may be used to provide a description of the physical or emotional harm, property damage or economic loss suffered by you as the result of the commission of an offence, as well as a description of the impact of the offence on you. You may attach additional pages if you need more space. Your statement must not include: . any statement about the offence or the offender that is not relevant to the harm or loss you suffered; any unproven allegations; . any comments about any offence for which the offender was not convicted; - any complaint about any individual, other than the offender, who was involved in the investigation or prosecution of the offence; or . except with the court?s approval, an Opinion or recommendation about the sentence. You may present a detailed account of the impact the offence has had on your life. The following sections are examples of information you may wish to include in your statement. You are not required to include all of this information. Emotional impact Describe how the offence has affected you emotionally. For example, think of: - your lifestyle and activities; - your relationships with others such as your spouse, family'and friends; . your ability to work, attend school or study; and . your feelings, emotions aEd reactions as they relate to the offence. called. Physical impact Describe how the offence has affected you physically. For example, think of: I ongoing physical pain, discomfort, illness, scarring. dis?gurement or physical limitations; - hospitalization or surgery you have had because of the offence; a treatment, physiotherapy or medication you have been prescribed; - the need for any ?n?ther treatment or the expectation that you will receive further treatment; and - any permanent or Mai-tit isabiliz.e (LC I Economic impact Describe how the o?bncc has affected you ?nancially. For example, think of: - the value of any property that was lost or damaged and the cost of repairs or replacement; . any ?nancial loss due to missed time from work; . the cost of any medical expenses, therapy or counselling; and - any costs or losses that are not covered by insurance. Please note that this is not an application for compensation or restitution. . un- ??utw?r pa u. Fears for security Describe any tears you have for your security or that of your family and lriends. For example, think 01: 0 concerns with respect to contact with the oi Tender; and . concerns with respect to contact between the ollender and members ol your lamily or close friends. . .- . . Drawing, poem or letter You may use this space to drau a picture at mile a poem or law It it will help you express the impact that the oti'encc has had on you. [E/l would like to present my statement in court. To the best oi my knowledge. the information contained In this statement is true. Dated this day oi" 30_ _i I at ngtifrws Signature ot'dcelamnl ?sz II you did so and the nature oi your If you completed this statement on hehall?ot'the victim please indicate the relationship to the viL (11 _Cm.ioe_ L. (C of Ii?Ls_ Dated Iis Sm 20111-3? WA?jV?/?i?wi . 1%th 8&0 18""Wyl?743 anala?wm/c?r (Ww News mm) m) (yea +Le acmred' #3?an Adqu mama a mix [ms CMOM ?a Mane hm (gm?3. pr{ IS ?Hr?e 6P 90f WOVt/moiij 09$ 100mb W: Maggi? [wk ?gment 7L0 0+ He bcft? ?In WU .191 OCCurt? 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You may Oilence Date Offence Location or emotional harm, property damage or econo a description of the impact of the offence on This form may be used to provide a description of the physics by you as the result of the commission of an offence, as well a attach additional pages ifyou need more space. Your statement must not include: . any statement about the offence or the offender that is not re - any unproven allegations; - any continents about any offence for whic - any complaint about any individual, other than the offender, who offence; or - exCept with the court?s approval, an opinion or recommend levant to the lranu or loss you suffered; the offender was not convicted; was involve of the cl in the investigation or prosecutio ation about the sentence. The following sections are examples of You may present a detailed account of the impact the offence has had on your life. lude all of this information. information you may wish to include in your statement. You are not required to inc Emotional impact Describe how the offence has affected you emotionally. For example, think of: - your lifestyle and activities; - your relationships with others such as your spouse, family and friends; . your ability to work. attend school or study; and - 0 your feelings, emotions and reactions as they relate to the offence. Physical impact Describe how the offence has affected you physi . -. - ongoing physical pain, discomfort, illness, sc, . hospitalization or surgery you have had beca 0 treatment, physiotherapy or medication you hi:- the need for any further treatment or the expe- . any permanent or long-term disability. 0 :qasgp no: mu 0,1. - - "@1va 1151 @376 g1 if'?ulln?- 1/ ?Ty gar Ding) 111133 51.11. . 1.7311311111171163 [Inugaupm may}, {11113111117213} [if .. pun 1apuago .9111 ua?auqaq 1:111in pun' Padpuago 91.11 mm 13311100 Ai?u?n'oias mo/E 'sp?m?g 5561316 5111118} mo? 90' sudq'maui a spuau; 'p'uu Kju'u?j max 30 115,111 :30 3mm; ?qdm?xs in suodmoa 1o; 1113101! 91-9 10 mumnsug Aq pan/1001011 91319111 2353911? pun :?umasunoo .10 811313111 ?sasuadxa [aggpg an ?ppm mm} mun passg 9.11ch 30 130:) mu pun pa?nmup .10 1501 snM_ 111 :30 xuun 10:1 n05 paldajil 'UOl?lans?-I .10 LID-I18 txuhmaaqwm .10 I I I I 3,333 has had emo 00621 Ibo/046% mange in 9, has 1966!?) Im mpg/3 8331130 'ecmf 1 81?) 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