Transcription of Application for Crime Victim Compensation
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Application for Crime Victim Compensation
State of CaliforniaVictim Compensation BoardForm VCGCB-VCP-005 (Rev. 10/2017) [ENG]Page 1 of 7 Application For Crime Victim CompensationAssociated Application ID(Enter if known)Section 1: ClaimantA separate Application must be filed for each person seeking 1 must be completed for all applications. The claimant is the person who has expenses or is seeking assistance as a result of a Crime . If you are filing this Application on behalf of someone else, put his/her information in Section 1 and your information in Section Spoken LanguagePreferred Written LanguageFirst NameMiddle NameLast NameGenderRelationship to VictimSocial Security Number (SSN)No SSNDate of BirthFrom the date of the Crime to now, has the claimant been in prison, on probation, on parole or post-release community supervision because of a felony?Is the claimant required to register as a sex offender?
Law Enforcement Agency Name If reported to law enforcement, name of the law enforcement agency Dates Crime Occurred From To Date Crime was Reported Crime Report Number Describe Injuries Person who committed the crime (suspect), if known Suspect unknown First Name Middle Name Last Name Location of Crime (if known) Address, Intersection, Area, etc.
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