Request Restitution

Complete and submit this form if you want to request restitution.

*Defendant's First Name: M.I.: *Last Name:

*Complaint No.:

*Your First Name: M.I.: *Last Name:

Exterior of Municipal Court Building
City Prosecutor's Office
Phoenix Municipal Courthouse
300 W. Washington, 8th Fl
Phoenix, AZ 85030-4500
Property: $
I am requesting restitution, however, at this time I do not have an exact dollar amount. I will be submitting a request as soon as I have receipts.
Vehicle Damage: $
Medical Bills: $
Funeral Expenses: $
Lost Wages: $
Insurance Deductible: $
Other: $
SUB-TOTAL: $
- Paid by Insurance: $
TOTAL RESTITUTION: $

Please provide copies of bills or other supporting documents within 10 days of submitting this form. You may provide copies by faxing them to the Victim Services Unit at 602-534-4540 or mailing them to:

Phoenix Prosecutor's Office
P.O. Box 4600
Phoenix, AZ 85030-4600
ATTN: Victim Services Unit

If you have questions or want to speak with an Advocate, you may contact the Victim Services Unit by calling 602-261-8192 or Send an E-mail Here .

Before you submit this e-mail form, you should be aware of the City's policy on the use of its e-mail systems. The policy states that the e-mail message you are about to send: (1) is subject to public disclosure under the Public Records Law, (2) is not private or confidential and (3) is retained for one month.

*Required field.



Last modified on 09/25/2009 14:41:48