Do I need a notary for the Crime Victim Compensation Application?

No. The form instructs the claimant to sign and date it and includes a declaration under penalty of perjury, but it has no notary block.

How do I submit the Crime Victim Compensation Application?

Mail it to the Crime Victim Services Commission, Michigan Department of Community Health, at 320 S Walnut, Lansing, MI 48913. The form also lists a fax number.

What documents should I attach to the application?

Attach a police report if available and itemized receipts for claimed expenses. The form also lists supporting documents for certain income and loss-of-support claims.

Who can complete this application?

The victim completes the victim information section. A parent or guardian of a minor victim, or a survivor of a deceased victim, also completes the claimant section.

Lenawee County, MI · Lenawee County

No notary required

Crime Victim Compensation Application (Spanish)

Spanish-language application for crime victims, eligible survivors, or guardians to request compensation through the 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: Oct 5, 2026
Machine-readable: JSON record · about the forms index

What this form is

This Spanish-language application requests crime victim compensation for eligible losses, including medical expenses, funeral expenses, lost wages, or lost support. It asks about the victim and crime, other resources and insurance, expenses, income, and the benefits sought. The form instructs applicants to attach available police reports and itemized receipts when applicable, and other documents for certain claims.

Who needs it

A crime victim, a minor victim’s parent or guardian, or a deceased victim’s survivor may use this application to request compensation.

How to submit it

Mail the completed application to Crime Victim Services Commission, Michigan Department of Community Health, 320 S Walnut, Lansing, MI 48913. The form also lists fax number (517) 373-2439.

About notarization

This document is signed without a notary; the claimant signs and dates the application, which includes a declaration under penalty of perjury.

How to submit this form

1
Download the Application
Download the Spanish-language Crime Victim Compensation Application.
2
Complete the Relevant Sections
Write clearly or type the requested information, completing sections that apply to the claim.
3
Gather Supporting Documents
Attach available police reports, itemized receipts, and other supporting documents requested for applicable claims.
4
Sign and Mail the Application
Sign and date the application, then mail it to the Crime Victim Services Commission at the address provided on the form.

Frequently asked questions

Do I need a notary for the Crime Victim Compensation Application?: No. The form instructs the claimant to sign and date it and includes a declaration under penalty of perjury, but it has no notary block.
How do I submit the Crime Victim Compensation Application?: Mail it to the Crime Victim Services Commission, Michigan Department of Community Health, at 320 S Walnut, Lansing, MI 48913. The form also lists a fax number.
What documents should I attach to the application?: Attach a police report if available and itemized receipts for claimed expenses. The form also lists supporting documents for certain income and loss-of-support claims.
Who can complete this application?: The victim completes the victim information section. A parent or guardian of a minor victim, or a survivor of a deceased victim, also completes the claimant section.

Need something notarized?

This Crime Victim Compensation Application (Spanish) doesn’t need a notary, but Michigan residents can notarize other documents online with a commissioned online notary.