Confidential 293 Form CORONA POLICE DEPARTMENT 730 PUBLIC SAFETY WAY CORONA, CALIFORNIA 92880-2002 CA0331500 CR# Crime:Victim ID# Date: MM slash DD slash YYYY Victim Advisement Pursuant to California Penal Code Section 293(a) and California Government Code Section 6254(f)(2) (A), you are informed that your name will be a matter of public record unless you request that it not become a matter of public record.I have been informed of the above right to privacy sections. Reset signature Signature locked. Reset to sign again (Signature) Victim/Parent/GuardianVictim’s Statement Check One: I hereby elect to exercise my right to privacy, pursuant to California Government Code Section 6254 and 293(a) PC. I do not elect to exercise my right to privacy and understand that my name will become a matter of public record and may become available for publication. Name (L, F, M) Date of Birth MM slash DD slash YYYY Residential PhoneResidence Address: Street Residence Address: City Residence Address: Zip Cellular PhoneBusiness Information Same as Residence Business Name & Address Business: City Business: Zip Business PhoneSex Race Height Weight Build Hair Eyes Reporting Officer: ID # 6254(f)(2)(A) Subject to the restrictions imposed by Section 841.5 of the Penal Code, the time, substance, and location of all complaints or requests for assistance received by the agency and the time and nature of the response thereto, including, to the extent the information regarding crimes alleged or committed or any other incident investigated is recorded, the time, date, and location of occurrence, the time and date of the report, the name and age of the victim, the factual circumstances surrounding the crime or incident, and a general description of any injuries, property, or weapons involved. The name of a victim of any crime defined by Section 220, 261, 261.5, 262, 264, 264.1, 265, 266, 266a, 266b, 266c, 266e, 266f, 266j, 267, 269, 273a, 273d, 273.5, 285, 286, 288, 288a, 288.2, 288.3, 288.4, 288.5, 288.7, 289, 422.6, 422.7, 422.75, 646.9, or 647.6 of the Penal Code may be withheld at the victim’s request, or at the request of the victim’s parent or guardian if the victim is a minor. When a person is the victim of more than one crime, information disclosing that the person is a victim of a crime defined in any of the sections of the Penal Code set forth in this subdivision may be deleted at the request of the victim, or the victim’s parent or guardian if the victim is a minor, in making the report of the crime, or of any crime or incident accompanying the crime, available to the public in compliance with the requirements of this paragraph. CPD Form # 17-001 (2017.04.19)Officer Email Select a Method For Victim's Copy Email Phone Victim Email Victim Phone Number