Restitution Worksheet

You are listed as a victim in this case. As a result, you are entitled to collect restitution, if the defendant is convicted and placed on probation. According to the Indiana Code, the court will base its restitution order on a variety of factors. You also may wish to file a civil lawsuit to recover damages; however, the prosecutor’s Office cannot assist with that. If you have paid or owe any money for bills because of this crime, please complete this form. If you do not require restitution, you do not need to fill out this worksheet. It is important to be as accurate and complete as possible. You must attach copies of any bills or other proof of money you have spent. If the documentation is not provided the Court may not order restitution. Use and attach additional pages if necessary.

Step 1 of 4

  • Property Damage

    Please list any personal property or belongings that were lost, destroyed, or damaged as a result of this crime, then record the value of the property. If you did not experience any property damage, please continue to part two of the worksheet. Up to eight items. Start with item 1 below.
  • Do not use the $ sign, commas or periods. For example, one hundred dollars should read 100.