Lenawee County, MI · Lenawee County
Crime Victim Compensation Application
Victims or eligible claimants use this application to request compensation for crime-related expenses through the Michigan Crime Victim Services Commission.
At a glance
- Issued by
- City of Lenawee County · Lenawee County, Lenawee County, Michigan
- Notarization
- Not required: file this form without a notary.
- Official source
- lenawee.mi.us
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
The application requests compensation for eligible crime-related costs, including medical expenses, counseling, funeral costs, lost earnings, and loss of support. The applicant provides victim and crime details, requested benefits, household income, and relevant insurance or recovery information. The document also includes a compensation checklist describing supporting records to submit for different types of claims.
Who needs it
A crime victim, or a claimant filing for a deceased, incapacitated, or minor victim, uses this application to request compensation.
How to submit it
Return the completed, signed application and supporting documentation to the Crime Victim Services Commission, Capitol View Building, 201 Townsend Street, PO Box 30195, Lansing, MI 48909, or fax it to (517) 373-2439.
About notarization
The application is signed and dated without a notary; a notarized statement is requested only 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 its compensation checklist.
- 2
Complete the Application
Print clearly or type. Complete the sections that apply and enter household income.
- 3
Gather Supporting Documents
Use the checklist to gather records for the compensation you are requesting, such as bills, insurance statements, or income documents.
- 4
Sign and Submit
Sign and date the application, then send it with supporting documentation to the commission by mail or fax.
Frequently asked questions
- Do I need a notary for the Crime Victim Compensation Application?
- No. Sign and date the application without a notary. A notarized statement is requested only if someone else paid funeral costs and authorizes reimbursement.
- How do I submit the Crime Victim Compensation Application?
- Send the 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.
- What supporting documents should I include?
- The checklist varies by benefit. It may include a police report, itemized bills, insurance explanations of benefits, pay stubs, a physician’s disability statement, or other records specified in the checklist.
- Who can file this application?
- A victim may apply, or a claimant may file for a deceased, incapacitated, or minor victim. The form says a separate application is required for each victim.