Virginia > Statewide > District Court > Criminal
Request For Confidentiality DC-301 - Virginia
| Request For Confidentiality Form. This is a Virginia form and can be used in Criminal District Court Statewide . |
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REQUEST FOR CONFIDENTIALITY Commonwealth of Virginia Va. Code §§ 19.2-11.01; 19.2-11.2 Case No.......................................................... TO: ............................................................................... [ ] Circuit Court [ ] General District Court [ ] Juvenile and Domestic Relations District Court Commonwealth of Virginia v. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Requested by: .......................................................................................................................................................... NAME ................................................................................................................................................................................... ADDRESS (OPTIONAL) ................................................................................................................................................................................... EMPLOYER NAME AND ADDRESS (OPTIONAL) ................................................................................................................................................................................... TELEPHONE NUMBER (OPTIONAL) VIRGINIA DRIVER'S LICENSE NUMBER (OPTIONAL) I, the undersigned, am a [ ] victim [ ] spouse or child of a victim [ ] parent or legal guardian of a victim who is a minor or [ ] spouse, parent, sibling or legal guardian of a victim who is physically or mentally incapacitated, or who was the victim of a homicide. The crime committed against the victim was [ [ [ [ [ [ [ ] ] ] ] ] ] ] a felony sexual battery in violation of Va. Code § 18.2-67.4 assault and battery in violation of Va. Code § 18.2-57 or § 18.2-57.2 stalking in violation of Va. Code § 18.2-60.3 attempted sexual battery in violation of Va. Code § 18.2-67.5 driving while intoxicated in violation of Va. Code § 18.2-266 maiming while driving intoxicated in violation of Va. Code § 18.2-51.4 [ ] witness in a criminal prosecution under Va. Code § 18.2-46.2 or § 18.2-46.3 I request that the above-named court(s) not disclose, release or allow to be examined any information as to my residential address, telephone number, place of employment or that of my family members except as specifically authorized by Va. Code § 19.2-11.2. The names of my family members to whom this request applies are: ................................................................................................................................................................................... ................................................................ DATE OF REQUEST ___________________________________________________ SIGNATURE OF PARTY MAKING REQUEST Received on ...................................... DATE AND TIME by __________________________________________________ [ ] CLERK/DEPUTY CLERK [ ] MAGISTRATE [ ] INTAKE OFFICER TO THE CLERK: PLACE IN A SEALED ENVELOPE FORM DC-301 (MASTER) 1/06 American LegalNet, Inc. www.USCourtForms.com
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