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#_________.