Eaton County, MI · Eaton County
Crime Victim Compensation Application
Victims or eligible claimants use this application to request compensation for crime-related expenses, lost earnings, funeral costs, counseling, or loss of support.
At a glance
- Issued by
- City of Eaton County · Eaton County, Eaton County, Michigan
- Notarization
- Not required: file this form without a notary.
- Official source
- eatoncounty.org
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
The application requests information about the victim, claimant, crime, household income, and requested benefits. It is for people seeking compensation through the Michigan Crime Victim Services Commission; the form says completion is required if compensation is desired. Depending on the benefits requested, applicants may need to include bills, insurance statements, pay stubs, medical documentation, or other supporting records.
Who needs it
A crime victim, or a claimant applying for a minor, deceased, or incapacitated victim, may use this form to request compensation.
How to submit it
Return the completed, signed application and supporting documentation to Crime Victim Services Commission, Grand Tower, Suite 1113, 235 S. Grand Avenue, PO Box 30037, Lansing, MI 48909; fax: 517-373-2439.
About notarization
The application is signed and dated without a notary; for burial benefits, the checklist calls for a notarized statement if another person paid funeral costs and authorizes reimbursement.
How to submit this form
- 1
Download the Application
Download the Crime Victim Compensation Application and compensation checklist.
- 2
Complete the Application
Print clearly or type; complete a separate application for each victim and fill in the sections relevant to the benefits requested.
- 3
Gather Supporting Documents
Include applicable bills, insurance explanations, pay stubs, medical documentation, and other records listed in the application and checklist.
- 4
Sign and Submit
Sign and date the application, then send it with supporting documents to the Crime Victim Services Commission address or fax number shown on the form.
Frequently asked questions
- What is the Crime Victim Compensation Application for?
- It requests compensation for eligible crime-related expenses or losses, including medical costs, funeral expenses, counseling, lost earnings, and loss of support.
- Who can complete this application?
- The victim completes the victim information section. A claimant completes the claimant section if the victim is a minor, deceased, or incapacitated.
- Do I need a notary for the Crime Victim Compensation Application?
- No. The application is signed and dated without a notary. For burial benefits, the checklist calls for a notarized statement if another person paid funeral costs and authorizes reimbursement.
- How do I submit the Crime Victim Compensation Application?
- Send the completed, signed application and supporting documents to the Crime Victim Services Commission at the Lansing mailing address on the form, or fax them to 517-373-2439.