Herkimer County Victims Impact Panel Application Form

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Herkimer County Victim Impact Panel Application Form

*Name:

Phone:

*Email Address:

*Mailing Address:

*City:

*State:

*ZIP Code:

Probation / Parole Officer Name:

Probation / Parole Officer Mailing Address:

*Court Convicted:

*Name Of Judge:

Court Mailing Address:

The Victim Impact Panel Program Course Fee is $50.00. The fee can be paid online through the AllPaid link below or, in person with cash, official bank check or money order or by mail with an official bank check or money order. Personal checks are not allowed. The address for in person or mail is: Herkimer County Treasurer, 109 Mary Street, Suite 2419, Herkimer, NY 13350. To make payment online, click on AllPaid Payment on the Herkimer County Victim Impact Panel Web Page under links. If you have any questions call the STOP-DWI/VIP Office at 315-867-1198 or email to stopdwi@herkimercounty.org.

Herkimer CountyVictim Impact PanelApplication Form

Herkimer County
Victim Impact Panel
Application Form