Montgomery County, Ohio, Prosecutor

CHANGE OF INFORMATION FORM
(for corrections or additions only)

State of Ohio vs.	(enter defendant's name)
Case Number:	- CR-
Victim's Name:
	I am the victim in the above-captioned matter. I can be reached through the information listed below.
	The victim is a child, elderly, deceased, incapacitated, or incompetent. The person listed below will be the victim’s representative.

Victim/Representative Name:

Mailing Address
Street:
City:
State:
Zip:

Home Phone Number:
Cell Phone Number:
E-Mail Address:
Work Phone Number:
Normal Work Hours:
Name of Alternate Contact:
Phone Number of Alternate Contact:
Relationship of Alternate Contact: