Example of a Typical Victim Impact Statement

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APPENDIX C

Example of a Typical Victim Impact

Statement

VICTIM IMPACT STATEMENT

DÉCLARATION DE LA VICTIME

SUPERIOR/ONTARIO COURT OF JUSTICE*

COUR SUPÉRIEURE DE JUSTICE/DE JUSTICE DE L’ONTARIO*

CANADA

PROVINCE OF ONTARIO

PROVINCE DE L’ONTARIO

Form / Formule 34.2

Subsection 722(4) of the Criminal Code

Paragraphe 722(4) du Code criminel

Toronto

(Region / Région) Case/File No. / N° du cas/dossier

Court Location: Superior Court

Adresse du tribunal:

In the matter of: R. v. John Smith

Dans l’aaire de: R c. (insert name of accused/oender / nom de l’accusé/du délinquant)

Victim/writer’s name: Jane Smith

Nom de la victime/du déclarant:

This form may be used to provide a description of the physical or emotional

harm, property damage or economic loss suered by you as the result of