ADMINISTRATION OF JUSTICE EL CAMINO COLLEGE PROFESSOR RAY LEWIS CONFIDENTIAL FILE NUMBER________________ Notice to: VICTIMS OF SEX CRIMES This form must be attached to all criminal reports related to the following California Penal Code Sections: 261, 261.5, 262, 264.1, 286, 288, 288a, 289. A separate form shall be completed for each victim. California Penal Code 293(a): “Any employee of a law enforcement agency who personally received a report from any person alleging that the person making the report has been the victim of a sex offense shall inform that person that his or her name will become a matter of public record unless he or she requests that it not become a matter of public record pursuant to Government Code 625.4.” I have read and understood the above paragraph. I have been informed of my right to have my name not become a matter of public record. ( ) ( ) My name can be made public. My name shall not be made public. Victim’s Signature____________________________ Date:_______________________________________ (If victim is under age 18, a parent or guardian’s signature should be obtained.) Witnessed by: (Police Department employee informing victim): Signature___________________________________________ID#________________________ TO BE COMPLETED BY POLICE DEPARTMENT EMPLOYEE: Victim (last, first, middle)_________________________________________________________ DOB___________________________________ Address ______________________________________________________________________ City/State/Zip Code______________________________________________________________ Telephone number H ( )__________________ W ( )___________________________ Race__________________ Sex __________________ SSN _____________________________ Notice to employee: If the victim (s) does not want his or her name to be a matter of public record, do not place the identifying information on the Crime Report. This form shall be the first page(s) of your report. In the narrative of the report, refer to the victim (s) as “Victim #1”, “Victim #2” etc., as applicable. Do not use the name of the victim in the narrative of the report. IN THIS REPORT THE ABOVE VICTIM WILL BE REFERRED TO AS VICTIM#_________.