Impact Statement: Homicide VICTIM IMPACT STATEMENT FOR PARENTS OF CHILD VICTIMSDate Sent MM slash DD slash YYYY Victim's Name Name and Relationship to Victim Commonwealth VS. CR # Prosecuting Attorney As the victim of a crime you have the right to offer a statement to the judge prior to the sentencing of the defendant. This form is provided to you for this purpose. Please address the impact that this crime has had on you and your family, but do not describe details of the crime itself. By law, a copy of this form must be given to defense counsel, if requested, prior to trial and it is thereby possible that the defendant will see it. If you have additional questions or need assistance, please call the Victim/Witness Department at (717) 771-9600. The completion of this statement is voluntary. 1. How has the loss of your loved one affected you and those close to you? Please feel free to discuss your feelings about what has happened and how it has affected your general well-being. Has this crime affected your relationship with any family members, friends, co-workers, and other people? As a result of this crime, if you or others close to you have sought any type of victim services, such as counseling by either a licensed professional, member of the clergy, or a community-sponsored support group, you may wish to mention this.2. Has this crime affected your ability to perform your work, make a living, run a household, go to school, or enjoy any other activities you previously performed or enjoyed? If so, please explain how these activities have been affected by your loss.3. Only if you feel comfortable in doing so should you use this space to tell the judge anything you would like him or her to know about your loved one and the kind of person he or she was. If you wish, you can write about any special memories you have of your loved one, times you shared together, what his or her hopes and dreams were, and any other information you would like to share with the judge.Date MM slash DD slash YYYY