CONFIDENTIAL VICTIM Attachments Check here if you would like to attach files with this form File Upload Drop files here or Select files Max. file size: 64 MB. Irvine Police DR#(Required) CONFIDENTIAL – NOT TO BE RELEASED TO ANYONEThis form shall be completed for each victim of any of the following reported crimes:SELECT ONE: 220 PC 261 PC 261.5 PC 262 PC 264 PC 264.1 PC 265 PC 266 PC 266a PC 266b PC 266c PC 266e PC 266f PC 266j PC 267 PC 269 PC 273.5 PC 273a PC 273d PC 285 PC 286 PC 288 PC 288.2 PC 288.3 PC 288.5 PC 288.7 PC 288a PC 289 PC 422.6 PC 422.7 PC 422.75 PC 646.9 PC 647.6 PC ABOVE CHARGES INCLUDE SUB-SECTIONSInvol: Name(Required) Last First Middle Sex Race DOB Month Day Year Age Height Weight Hair Eyes DLN DL State Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneOccupation Bus. Add (School, if Juv) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Bus. PhoneEmail Address Cell Phone #Additional Information If Juvenile Victim, complete following on parent/guardian: INVOL CODE = PAR/Parent of OTH/Guardian in box 27.Invol: Name Last First Middle Sex Race DOB Month Day Year Age Height Weight Hair Eyes DLN DL State Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneOccupation Bus. Add (School, if Juv) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Bus. PhoneEmail Address Cell Phone #Additional Information In accordance with Section 293 of the California Penal Code and Section 6254F(2) of the Government code, the law enforcement agency receiving a report from a person alleging being a victim of one of the above listed crimes, shall determine if the alleged victim wishes to withhold their name from public release.WAIVER A. MY NAME CAN BE MADE PUBLIC. B. MY NAME SHALL NOT BE MADE PUBLIC. Signed(if juvenile, parent/guardian)Date/Time Witness: (Officer)Date/Time IF VICTIM IS UNABLE TO COMPLETE THIS FORM DUE TO PSYCHOLOGICAL AND/OR MEDICAL REASONS, OFFICER SHALL CONSIDER ALLEGED VICTIM HAS CHECKED “B” ABOVE AND NAME SHALL NOT BE MADE PUBLIC.