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Restitution Request

Please correct the field(s) marked in red below:

If you have incurred out-of-pocket expenses as a direct result of this crime, you may be eligible to request restitution. Expenses may include, but is not limited to:

  • Repairs to damaged property or replacement costs
  • Medical/Dental bills
  • Lost Wages
  • Transportation to and from court hearings
  • Counseling
  • Funeral Expenses
  • Crime Scene Clean-up

Full Name
Date of Birth
Docket Number
Mailing Address
Primary Phone
Primary Phone
Secondary Phone
Secondary Phone
Email Address
Restitution Requested
Restitution Requested

Criminal restitution covers out-of-pocket expenses only. Expenses covered by insurance, pain and suffering, and other related losses are not eligible if covered by some other means. Please contact our office for more information or regarding other civil remedies.

DOCUMENTATION REQUIRED: Documentation may include, receipts, estimates, pay stubs, invoices, etc. Please upload your documentation below or send to:

Mesa City Prosecutor’s Office
Victim Services
PO Box 1466
Mesa, AZ 85213

email: or
fax: 480-644-2584

  1. To receive a copy of your submission, please fill out your email address below and submit.

    PDF or Off-site Forms

     Department/Division Form
    Alarm Permit
    See Alarm Permit page to apply for, renew or update permit
    Benefits See Benefits forms page
    City Clerk Period No Activity Statement (Committees)
      Annual No Activity Statement (Committees)
      Campaign Finance Report (first page)

    Campaign Finance Report (full report)
      Termination Statement
      Claim Against the City of Mesa
      Clarification of Interpretation
    See Court Forms page
    Customer Service (my utility account)
    ABC Program Enrollment

    Request a NEW account




    Request ADDITIONAL utility service


    Gas Service Request


    Turn OFF utility service




    Mailing Address Change


    Budget Billing

      Paperless billing
      Select Due Date
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      Bulk pick-up request
      Barrel repair or replacement

    Missed barrel pick-up request

      Grass to Xeriscape Rebate program

    Wastewater Fee adjustment

      Water Meter Set Request
    Deferred Compensation
    Empower Retirement Services
    Development Services

    See Development Services forms:

    Title VI Compliant Form
    Energy Resources
    Natural Gas Rebates
     See Engineering policies & forms page
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      Fire, Medical & Investigation Reports
      Tent/Canopy Permit Application
    Film Mesa
    Film Permit (Film Permit Procedures)

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    See Licensing List & Forms
    See Planning Forms page
    See Police Services & Forms
    Real Estate Services
    Alley Abandonment Application
    Tax Audit
    See Tax Forms
    Solid Waste
    Clean Sweep/Green Sweep Program

    Volunteer opportunities & applications

    Fire & Medical Volunteer Interest Application

    Water Resources
    Sewer Blockage Inspection and Removal Service


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