Mississippi Parole Board 
Victim Parole Notification Form

 

Crime Victim Notification of Parole Hearing

(PLEASE DO NOT COMPLETE THIS NOTIFICATION REQUEST FORM UNLESS YOU ARE A VICTIM OF CRIME, A SURVIVOR OF A HOMICIDE  VICTIM, OR A WITNESS TO A CRIME)

As a victim of crime, the Mississippi Parole Board will notify you of the date a parole hearing is scheduled for the offender. Letters are sent by the Mississippi Parole Board within 30 days prior to the scheduled parole hearing. To be notified by the Mississippi Parole Board of the offender's parole hearing, you must complete this form and submit it to the Mississippi Parole Board.

  1. Name of Offender

     

  2. Offender MDOC Number

     

  3. County of Conviction and Crime (County; Crime)

      
     

  4. Enter the date of  Sentencing

      -- mm/dd/yy

     

    *Please enter YOUR (The victim requesting the information) name and address.*

     

  5. Enter E-Mail Address

     
     

  6. Relationship to victim: 

  7. Address          
Name 
Street Address 
Address (cont.)
City 
State/Province 
Zip/Postal Code
Country

Phone Numbers

Work Phone
Home Phone

Cell Phone

 

If you are unable to electronically send this form, please contact us at:

   State of Mississippi Parole Board

                                           660 North Street                                          

Suite 100A

 Jackson, MS 39202

Phone: (601) 576-3520

Fax: (601) 576-3528

 

Message to Crime Victims:

For timely offender notification, be sure to contact the Parole Board of any changes in your address or telephone number.

MDOC Webmaster.
Copyright © 1999 Mississippi Department of Corrections. All rights reserved.
Revised: June 29, 2010