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  • Declaration Of Victim Losses Form

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W henever possible attach copies of receipts of insurance payments. Personal Property auto or homeowners insurance Name of company Medical insurance Claim No. Phone No. Other--list sources and amounts Have you applied for crime victim compensation benefits Yes If you received compensation as a result of your claim please list the amount No Total money received from insurance crime victim compensation and other sources Upon completion of this work.

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Please describe any changes in your life as a result of this crime and any additional information you would like the court to consider about the impact this crime has had on your life, such as changes in personal welfare, lifestyle, or family relationships.

What is the purpose of a Victim Impact Statement? It provides an opportunity to express in your own words what you, your family, and others close to you have experienced as a result of the crime. Many victims also find it helps provide some measure of closure to the ordeal the crime has caused.

For example, you can say how many people you have helped (for example, a number of participants in an extension program or clinical trial), how long your work has lasted or will last or how many people might be reached by a report you intend to write. Numbers help understand the importance of your work.

What should I include in my statement? How life has changed for you and those close to you. How your ability to relate to others has changed. Any counseling or other support you have obtained. Fees incurred for counseling or therapy for you and your family.

Example: Every morning when I wake up, I have to remind myself that my attacker won't be able to hurt me today. If I don't tell myself that I simply can't get out of bed. Since I was assaulted I have lost the full function of my right leg.

A victim's impact statement letter should include: A *brief* summary of the harm or trauma suffered by the victim or family as a result of the crime. A summary of the economic loss or damage suffered by the victim as a result of the crime. Include requests for restitution for out-of-pocket expenses.

Example: Every morning when I wake up, I have to remind myself that my attacker won't be able to hurt me today. If I don't tell myself that I simply can't get out of bed. Since I was assaulted I have lost the full function of my right leg.

A victim's impact statement letter should include: A *brief* summary of the harm or trauma suffered by the victim or family as a result of the crime. A summary of the economic loss or damage suffered by the victim as a result of the crime. Include requests for restitution for out-of-pocket expenses.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232