Impact Statement: Personal Injury Crimes VICTIM IMPACT STATEMENTDate Sent MM slash DD slash YYYY Victim's Name Commonwealth VS. Case # Prosecuting Attorney As the victim of a crime you have the right to offer a statement to the judge prior to the sentencing of the defendant. This form is provided to you for this purpose. Please address the impact that this crime has had on you and your family, but do not describe details of the crime itself. By law, a copy of this form must be given to defense counsel, if requested, prior to trial and it is thereby possible that the defendant will see it. If you have additional questions or need assistance, please call the Victim/Witness Department at (717) 771-9600. The completion of this statement is voluntary. 1. How has this crime affected you and those close to you? Please feel free to discuss your feelings about what has happened and how it has affected your general well-being. Has this crime affected your relationship with any family members, friends, co-workers, and other people? As a result of this crime, if you or others close to you have sought any type of victim services, such as counseling by either a licensed professional, member of the clergy, or a community-sponsored support group, you may wish to mention this.2. What physical injuries or symptoms have you or others close to you suffered as a result of this crime? You may want to write about how long the injuries lasted, or how long they are expected to last, and if you sought medical treatment for these injuries. You may also want to discuss what changes you have made in your life as a result of these injuries.3. Has this crime affected your ability or any family member's ability to perform work, make a living, run a household, go to school or enjoy any other activities you previously performed or enjoyed? If so, please explain how these activities have been affected by this crime.Date MM slash DD slash YYYY