GEORGIA DEPARTMENT OF CORRECTIONS & PAROLE BOARD
OFFICE OF VICTIM SERVICES
Victim Notification Request

** All Information Contained in This Form Will Be Kept Strictly Confidential **

This form should be completed and submitted to the Office of Victim Services after the defendant has been sentenced to the custody of the state prison system. Once the Georgia Department of Corrections has taken custody of the defendant, the Office of Victim Services will send you a letter acknowledging the registration of your request for notification.

Once registered, you will receive notification of final parole decisions (in those cases where an inmate is parole eligible), as well as notice of the release of the offender from the custody of Corrections. For additional information, please call the Office of Victim Services toll-free at 1-800-593-9474, locally at 404-651-6668, or visit our website at www.pap.state.ga.us.
State Board of Pardons and Paroles - Office of Victim Services
2 Martin Luther King, Jr. Drive, S.E., Balcony Level, East Tower
Atlanta, Georgia 30334
Fax 404-465-3567

If you have previously registered and need to advise us of a change in your mailing address, email address or telephone number(s), please submit an address change notification. It is your responsibility to notify the Parole Board of any mailing address, email or phone number changes. Otherwise, information may not reach you.



INMATE INFORMATION

Inmate Name:
Inmate's EF#:
Inmate's SS#:
(If Known)
County of Conviction:
Sentence Date:
Offense(s)

(If you do not know the inmate's I.D.#, please provide DOB and Gender as listed below.)
Date of Birth:
Gender:
Male
Female

VICTIM INFORMATION
Victim's Name:
Date of Birth:
Person Requesting notification (if other than victim):
Contact Person:
Relationship to Victim:
Your Mailing Address:
Your City:
Your State:
Your Zip:
Your Home
Phone #:
Your Work
Phone #:
Your Cell
Phone #:
Your Email
Address:

revised August 2011