2. Act 71 Compliance Form - District Court 15-01-01

4. Defendant Name*
6. OTN / Live Scan Number (if known)
7. Incident Number
9. Arresting Officer
11. Victim Name
12. Victim Date of Birth
14. Victim Address
16. Victim Phone
17. Victim Email
19. Notes
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21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

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