Confidentiality Advisement Form Date MM slash DD slash YYYY IncidentSuspectCode SectionOfficerOfficer ID #Sexual Assault Sections:220, 261, 262, 264, 264.1, 286, 288, 288a, 289, 293 Violence Sections:273a, 273d, 273.5, 422.6, 422.7, 422.75, 646.9, 679, 680 Penal Code 293, Marsy’s Law, Gov. Code 6254, Proposition 9 – Victim’s Bill of Rights The reporting officer for this investigation advised the victim or witness, or parent of the victim or witness, of his or her right to remain confidential for this report and not have their name and address released as a matter of public record per Penal Code 293, Marsy’s Law, Government Code 6254, and Proposition 9 – Victim’s Bill of Rights. CONFIDENTIALITY ADVISEMENTYour (or you child’s) name and address will become a matter of public record and subject to release unless you request that the name and address not become a matter of public record. I DO want my/my child’s name and address to become a matter of public record. I DO NOT want my/my child’s name and address to become a matter of public record. Victim/Witness Name & DOBVictim/Witness AddressVictim/Witness Phone(s)Business/School AddressBusiness/School PhoneEmail Address For Juvenile Victim/WitnessParent/Guardian NameParent/Guardian AddressParent/Guardian Phone(s)Email address to send a copy of this form to:(Required)