VICTIN' NAME: VICTIM IMPACT STATEMENT DECLARATION DE LA VICTIME: speRORONTARIO“ COURT oF alsTICE RC DE WISTICEREUSTICE BE CONTARO" ‘oimis TA ‘ocr 9 ara cel Southwest Region fetta oa out Location: ‘eased bi: 15 Huntr toot, Woodstack Ontario Intnematorat Rv, veinwirsrone Chadcea ew (Sileox) nemao ve Cindcea, Tee This form may be used to provide a description ofthe physical or emotional harm, property damage or economic loss suffered by you as the result of the commission of an offence, as well as a description of the impact ofthe offence on you. You may atlach additional pages if you need more space. La présente formule peut étre utillsée pour présenter une description des dommages—matériets, corporels ou moraux-—au des pertes économiques qui vous ont été causés par suite do fa porpétraion lune infraction ainsi que des réporcussions que Mhfraction a cues sur vous. Vous pouvez ajoutor dos pages addtionnelles au besoin, ‘Your statoment must not include: La déclaration ne peut comportor : + any statement about the offence or the offender that isnot refevant tothe harm or loss you suffered; de propos concernant fnfraction ou fe délinquant qui ne sont pas pertients au regard des dommages ou pertos que vous avez subis;, + any unproven allegations; ‘allégations non fondées; any comments about any offence for which the offender was not convicted; de commentaires sur des infractions pour lesquells le déinquantn’a pas &t8 condamné; + any complsint about any Individual, other than the offender, who was involved In the investigation or prosecution ofthe offence; or do plaintes au sujet cfun particule, autre que fe détinquant, qui était associé & Fonquéte ou a la pours do Pintaction; + except withthe court's approval, an opinion or recommendation about the sentence. sauf ayec la permission du tribunal, de points de we ou de recommandations au sujet de la pelne, ‘You may present a detaled account of the impact the offence has had on your life, The following sections are examine af information yout may wish to ielile In yout statement Your are net required to ince all ofthis information. Vous pouvez présenter un compte rendu détallé des répercussions de Hniraction sur volre vie. Les sections creprés ne consitvent que des exemples de renseignements que vous pouver Inclure dans Vvolre déclarafln. Vous ndles pas obligédfinclure tous ces renseignements.[Emotional impact épercussions d'ordro émotit oss ow fence hs tt ated you satay. Foren, ese acme poss tard ote aon ob Ss, po xn, nC cone your Hoste and eve: toa mada do wo otves soe, + youth tr nou ay a ne ‘avec los aul, rtammant vate épout ou pause, volo faniloot ves amis; + you soy tower aan choot iy a Tecan Unto: Roger obo or, + your fangs, ros and acon he ele he SSISEEES re tote vr ian ipso ean Deoling with times of depression aod Ceuslention continue do plagve ooh We ad non foc the ok except he ree ofFenses thal led EOeheier ere ql 2 ad shel Felner passing, o e) weeded m were ollowed epped lo save Lal cann = utcombratted wel enalely ahd live Being a senior emploge& working in hong pack tene Van conkatally ceminded of | each Knausin mu. Felher ancl v4 breaks 4 . Cy erie “OF emobonal pan were “Shell dealt by someone Faking Wis Ve and nol wilh Compassion Od a elderly and b'T C cesidents dederve LT 4 focal es are now clouded wilh Ud ad Leace Anyone havi the fiat el Gesision of plecin {Row loved Anemselues AN the ore arm Care, Ai Peiew es one OF thes oR a Shean geh o be Now feac did mat we Yooper fo them ao wel | muraPhysical impact Réporcussions d'ordre physique Desc how the ofence has afte yu phys. For example think of eullez dere fos rporussions corde yatqu que faction & cues Sur Yous, par exon, on c8 qu concome. + angsing sysical pin ascot tess, scaring, siguremant or ysl entation, te daiear physique present, Fincnfo, fs maa, os cates, a + hospitalization cr uray you have has because of be fence: tio hospatsaton ou ds trenton ‘42 ous ver dl subieoh ann do inactin: le rations phystuns 'uetment,pysoharapy or medleaon you have been prescribed, ‘os tatleiens, fa piysothéapie ou es medicaments ul vous oe pros; + tho nad fay furthr teatnent he expectation hat you wl feeive futher werent and Ine lententemypaartnne rr onPon ton Amon any permaratorlng-tern desl, te vale pamanentoou de fang dbo, toh dea\ing wilh ofCense \ hove. had geo several visits with a professional councellor « dhe Nad Suggested i. and d\ress leave at “hich an eanne atGocd» ny appoinimends will comb one detinalelys _ Ree edllor ib deying de hele me, SP my dad. again and cea’ hoon & \o do can change or de ne ahaa ee Pa e tat \) con jhe parle Y anly mer cvormims peso a[Economie Impact Réporcussions d'ordre économique Decaibe how te ofene has atected you fan. Fr example tik of veer dere es repercussions derek dconemguo quo nfacton a ous sur vous, par example, en co quconceme the valu fan propel tht waft of damaged ad the eos of reps or replearent [aval des bans pods ou du eco do répara cu do rlacomant do cos blens + ary finance oss deo sted tne fom work, ‘es partes inaeiosiputabios&Fabsonee dl rat, the cost of any matic! expense, haar or counseings Js dponcos medals ol all doa fherapi of du counsel; ‘ny oes or noes that are not covered by insane Ine cnt pina panacea snp nts par Fann Ploaso note that tis is not an application for componsaton or restitution. Veulte noter que la présent deeleraton ne constto pas une demande dindemnlstion ou de dédommogement ‘ eeauena had nod cost me much Ven oe wages bul’ \ have taken a gers es cay From eoork fo ease Sew Wered re Tne Shrebs of work the a ebicament Ynal Mie cree ke VO thoes around » Var unable te, rel pees Jeave a4 Loam pact-hmve eenpleyee exormgm antes ooFears for security (Craintes concornant la sécurité Deserve any fears you have for your seeuly or that of your family and tends. Fo example, tink of uit cr ou cans que vous avez pour ae acuré oy eal de vo faa i os am ar axemg + concerns with rospoc ta contact wth te ofr: an tg prtoccupatons canceman es canis ves dln + cones with expect to contact btvean the eflender an membre of your fry or lose ed des préocevpains concernant des contacts ete fs dayne dos mab devote fara ds ami proces a ceo ratec one ponte(Drawing, poom or letter (atech a separate pagel needed) Dessin, poeme, lettre fone une page etonele au besoin) You may wots spate daw a peor wet a acm or ti lp you ores eine athe fence hs a on you Yous pouvez ue et espace pour fae un dessh ou dre un pode oy uno ol st cal pout vous alder & dpa los [sspercuslons que ration a eves sur vous. { | Baars specs tenia areneor lee “aimorateprésantoline ma dcaarton devantfe tural, Roading it | Jometetatmy Area he natn conan hi sara ian ' Ama comeissace Je renseignements conta dan Ta reson dclaraon son exact, se Dated this / 22 day ot J cone wo l7, Fait co 08" ‘ 1 “ydondteck — Dolanto ta: i } tea ens nn | corm mont nea |i you compte this statement on baba af he vil pleas dco the veszona why you dd wo and the hare of you] sion cn, us ate amp prone alate anon cl vs, vuln alors pour equ vous ves | alas! que fa nature de votrs relation avec ole, pores ‘a if yu se atthe parson again whom ho aence was corunlted Bute camplang bs fam on your own Behl, paso] nse your eatonep wih the lm. Si vous tes pasta persone cane ql into a 8 commise, mals quo vou anise? fe présent fouls pour vata ero compl, vel iniuer vols len avec vite. Date ay of 7. Fates ura a ee Saar ‘aes ‘ii OTT Sse eT nel (please prin cxoragmenmesn eae?