*MN RESTRICTED (when complete) XII:OWN011 occurrence timber 1 URN 7010836 I . Name of Witness: _J Martha THOMSON Horne address: Ma Noble: n/a Erne address: I Len, [Sohn. No.: 46 WA team. h,.. Preferred means of contact (specify details): Email Gender: Female I Date and Mace of Earth: in/a Former Name: DIXON I (16.1 lbrid)ty : Code I ICI DATES OF WITNESS NON- AVAILABILITY: Yillnliitiatil a) Is the witness mans and VOW to attend court? If 14o; indne reason(s) on Mon MG6 b) What can be done to ensue &lender*? C) Does the witness require a Specie Measures Assessment as a vutzrable or Intimidated Jobless? (nth under 18; oneness with date, decider. /8~9 or Phrlia l alistikTY; ar " ties° fear of ring evidence a softness Is the complainant In a spud offence re) If wee, submt MG2 with fee in aneopated not suety, contested or wag* only cases d) Does the witness have any particular needs? Uses', what are they? (Disability, healthcare, rnildcare, transport, language OfhoultleS, visually Impaired, restricted mobility or other concerns?) Witness Consent (for witness comoistionl a) The Victim Personal Statement scheme (Victims only) has been monad to me: Yes O No O k, '''' I have been given the Victim Personal Statement leaflet and Select web to make a Victim Personal Statement at this time. Yes O No O c) I have been Gwen the leaflet "Gang a witness statement to the poke - al* happens red." Yes O No O 10 I consent to peace Ornng access to my medical record(s) in relation to this ;ratter (obtained In accordance vellti local practice): Yes o No O N/A O e) I consent to my metrical record in relation to this matter being clsdosed to the defence: Yes O No O N/A O I) I consent to We statement being disclosed for the purposes of dal proceedings if e.g. ack Yes O No O N/A O mdlotle, chid care proceedngs. g) thee wiener eases way. I have had to provision reganhng rePorbng fenthcbons manned to me. I w