Crime Victims Compensation Application

CRIME VICTIMS COMPENSATION APPLICATION. The application must be completed by one of the following: 1) A person who was the victim of a violent crime should fill out the application; or 2) If the victim is under the age of 18 or under a legal disability, then the victim’s parent or legal guardian should fill out the application; or 3) When seeking reimbursement for their own expenses, the parent, spouse, or child of a person injured or killed as a result of a violent crime can fill out the application; or 4) Any person that has paid or become obligated to pay expenses of the victim (medical / hospital, funeral / burial, psychological treatment of a mental or emotional condition caused or aggravated by the crime) can fill out an application. The application must be signed by either the applicant, or the victim’s parent or legal guardian if the victim is under 18 or under a legal disability. Documents to support your request for compensation will be required to process your claim. If available, please send copies of all the documents you have with the completed application (e.g., police report, plenary order of protection, civil no-contact order, hospital, or doctor bills). If you do not have all the documents available, collect copies of any additional documentation so that you will have it available when we contact you. www.FormsWorkflow.com