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Get Personal Injury Application - Connecticut Judicial Branch

Please know that it is important that you tell OVS if your contact information changes. If we cannot reach you, you may miss important deadlines set by state law or your claim may be closed. The highlighted Sections 1, 7 or 7a, and 10 must be completed. SECTION 1 VICTIM INFORMATION The person who was physically injured because of the crime. Title: Mr. Ms. Mx. Name of victim (first, middle, last) Birth date (mm/dd/yyyy) Age City Address Daytime phone number Cell phone.

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