Seeking Victim Information in Jordan Fautz Investigation

Introduction:
The FBI Louisville Field Office is seeking to identify potential victims of Jordan Fautz. If you or your minor dependent(s) have possibly been victimized by Jordan Fautz, please fill out the following questionnaire. Victims may be eligible for certain services, restitution, and rights under federal and/or state law.

Your responses are voluntary but may be useful in the federal investigation and help identify you as a potential victim. Based on the responses provided, you may be contacted by the FBI and asked to provide additional information. All identities of victims will be kept confidential.

Additional Resources:
DOJ Office for Victims of Crime - Help for Victims
National Safe Place Network
National Child Traumatic Stress Network
National Suicide Prevention Lifeline | 800-273-8255
Rape, Abuse & Incest National Network (RAINN)
National Center for Missing & Exploited Children

Contact Information

First Name

Middle Name

Last Name

Date of Birth (mm/dd/yyyy)

Phone Number (no dashes, spaces, or parentheses)

Email Address

Address Line 1

Address Line 2

City

State

Country

ZIP/Postal Code

Questionnaire

1. I am filing this form out on behalf of:

a. Myself
b. My minor dependent(s)

Minor Dependent 1:

a. First Name

b. Middle Name

c. Last Name

Date of Birth (mm/dd/yyyy)

Minor Dependent 2:

a. First Name

b. Middle Name

c. Last Name

Date of Birth (mm/dd/yyyy)

Minor Dependent 3:

a. First Name

b. Middle Name

c. Last Name

Date of Birth (mm/dd/yyyy)

3. Did you or a minor dependent(s) have contact with Jordan Fautz?

a. Yes
b. No
c. Unsure

4. Please provide a brief physical description of the minor(s).

5. What years did the minor attend St. Stephen Martyr (consider adding a date range if applicable)?

7. Do you have any additional information about the minor that may be relevant to the investigation?

PLEASE DO NOT SEND PICTURES AT THIS TIME.

Privacy Act Statement

The FBI is authorized to collect the information on this form by one or more of the following provisions: Title 28, United States Code, sections 533 and 534; Title 28, Code of Federal Regulations, section 0.85; and the Attorney General Guidelines for Victim and Witness Assistance. The information requested will assist the FBI in providing you with assistance to which crime victims are entitled under federal law. You do not have to provide the requested information; however, failure to do so may hinder the FBI in providing you with crime victim assistance. The information collected on this form is protected by the Privacy Act of 1974, as amended, Title 5, United States Code section 552a, and is maintained in the FBI’s Central Records System, DOJ/FBI-002, a description of which was published in the Federal Register at 63 Fed. Reg. 8671 (Feb. 20, 1998) and which may be viewed at www.justice.gov/opcl/doj-systems-records#doj

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Seeking Victim Information in Jordan Fautz Investigation

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