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Peninsula/South Bay POMC, Santa Clara, California

Address changes and Member Statistics
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Our Loved Ones, We will never forget
Address changes and Member Statistics
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Symbolic Ways to Honor Your Loved One

If you have a change of address, please email it to us at: southbaypomc@hotmail.com  OR snail mail to: POMC, 215 Liberty Street, Santa Cruz, CA 95060-6514
 
Your name:
New address:
Town, State, Zip:
Email address:
Telephone #: (          )
Mobile telephone #:  (          )
 
If you have not shared information with us before or have a correction to our information, please fill out the form below:
 
Your loved's ones' name:
Relationship to you:
Their birthday:
Their day of murder:
Their age at time of murder:
 
We appreciate how difficult the following questions can be for you to answer however we use the facts inside our records for statistics for speaking engagements, newsletters and grants.
 
If you are willing to share with us the information about the murder, you need only do it once and we will retain it in our recordds.
 
Method of Murder:  Gun ___ Knife ___ Beating ___ Auto ___ Other, please specify __________________________________________________
 
City and State where the murder was committed:
__________________________________________________
 
Murdered by:  Stranger _____ Family Member _____ Acquaintance ____
 
Parole Status:  Hearing? _____ Denied ______ Paroled _____
Case Status: 
Solved ____ Unsolved ____ Acquittal ___  Plea bargain ____
 
Total # of perpetrators _____  Male  _____  Female _____
Age of perpetrators:
 
Sentence imposed:______________________________________________
____________________________________________________
____________________________________________________
 
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Peninsula/South Bay California Chapter POMC
215 Liberty Street
Santa Cruz California 95060-6514

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