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APPLICATION and INSTRUCTIONS CRIME VICTIMS COMPENSATION  Form

APPLICATION and INSTRUCTIONS CRIME VICTIMS COMPENSATION Form

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Compensation Program is the payor of last resort. A criminal history report will be completed on all victims/witnesses and claimants 18 years of age and older. Please check all that apply. HOW DID YOU HEAR ABOUT US Referring Agency listed in Section 9 United Way 211 Clergy/Religious Leader My Doctor/Dentist My Counselor Hospital Staff Internet Search Newspaper Radio/Television Funeral Home Family/Friend/Neighbor Victim Services Advocate SUBROGATION AGREEMENT ACKNOWLEDGEMENT Brochures Poster...
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