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Get CT JD-VS-28 2011-2024

S 1. 2. 3. 4. Print or type the information requested. The form must be signed by the person who signed the application for victim compensation. Keep a copy for your records. Mail to the address below or fax to 860-263-2780. Mail to: Office of Victim Services, 225 Spring Street, Fourth Floor, Wethersfield, CT 06109 Name of Victim Claim Number Name of claimant or person filing for claimant Claims examiner Check the appropriate box: The claimant was a minor at the time of the criminal incide.

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