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Victim's Request for Dismissal

  1. I am the complainant in, or was a victim of, an assault and battery which will herein after be known as the charge, committed by the offender listed above on or around the incident date listed above. I have been advised and understand that before I make a decision regarding whether or not I should request a dismissal of the charge against the Defendant, and before I execute this, Request For Dismissal Of Domestic Assault & Battery Charge, that I have consulted with a Victim Advocate of the Lenawee County Prosecuting Attorney’s Office. Although I have been advised that I should not request a dismissal of the charge against the defendant in this case, it is my desire that this charge be dismissed. I acknowledge and understand that domestic violence, spouse abuse, or violent behavior by one person against his/her companion is virtually never an isolated incident or one-time occurrence and that I am in danger of being a victim of further violence by the defendant in the future. In spite of this fact, I still desire and request that the charge against the defendant be dismissed. I acknowledge that I have not been asked to dismiss or seek dismissal of the charge against the defendant by any person, including the defendant. I acknowledge that no person including the defendant, has coerced or threatened me, or attempted to coerce or threaten me, to get me to request dismissal of the charge. I further acknowledge that I have not received anything, nor have I been promised anything which has or would influence me to request a dismissal of the charge. My request to dismiss the charge is an act of my own free will and I am not under any duress by any person or party as I make this request. By signing this Request For Dismissal Of Domestic Assault & Battery Charge, I, on behalf of my heirs, representatives, successors, and assigns, hereby release and forever discharge the Arresting Agency, and the Lenawee County Prosecuting Attorney’s Office, its employees and/or agents of, from any and all liability, rights, actions, causes of action, debts, damages, claims, and demands whatsoever, at law or in equity, known or unknown, whether currently existing or not, which I now have, ever had or may have in the future, against the Arresting Agency, or the Lenawee County Prosecuting Attorney’s Office, its employees and/or agents of, for based upon, by reason of, or in any way related to the incident resulting in the charge or the dismissal of the charge, any and all events which may occur as a result of the charge having been brought or dismissed, and any and all events which may occur as a result of the failure to prosecute or punish the defendant for the charge.

  2. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  3. Required Meeting with Advocate*

    I agree that in order for this request to be considered, I must meet with a Victim Rights Advocate at the Prosecuting Attorney's office.

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  5. This field is not part of the form submission.