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Fill and Sign the In the District Superior Court for the State of Alaska Form

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CR-101 (9/94)(cs)(8 ½ x 5 ½) Crim. R. 44(f) & Adm. Bull.53 CERTIFICATE/VICTIM’S RIGHTS ACT AS 12.61.110, AS 12.61.130 IN THE DISTRICT / SUPERIOR COURT FOR THE STATE OF ALASKA AT ) ) Plaintiff, ) ) ) ) CASE NO. CR ) Defendant. ) CERTIFICATE OF COMPLIANCE WITH ) VICTIMS' RIGHTS ACT OF 1991 Attached is the following document: CERTIFICATION I certify that this document and its attachments do not contain (1) th\ e name of a victim of a sexual offense listed in AS 12.61.140 or (2) a residence or business address or telephone number of a victim of or witness to any crime unless it is an address used to identify the place of the crime or it is an address or telephone num ber in a transcript of a court proceeding and disclosure of the information was ordered by the court. Date Signature of Party or Attorney Type or Print Name CR-101 (9/94)(cs)(8 ½ x 5 ½) Crim. R. 44(f) & Adm. Bull. 53 CERTIFICATE/VICTIMS' RIGHTS ACT AS 12.61.110, AS 12.61.130 IN THE DISTRICT / SUPERIOR COURT FOR THE STATE OF ALASKA AT ) ) Plaintiff, ) ) ) ) CASE NO. CR ) Defendant. ) CERTIFICATE OF COMPLIANCE WITH ) VICTIMS' RIGHTS ACT OF 1991 Attached is the following document: CERTIFICATION I certify that this document and its attachments do not contain (1) th\ e name of a victim of a sexual offense listed in AS 12.61.140 or (2) a residence or business address or telephone number of a victim of or witness to any crime unless it is an address used to identify the place of the crime or it is an address or telephone num ber in a transcript of a court proceeding and disclosure of the information was ordered by the court. Date Signature of Party or Attorney Type or Print Name

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