Unclaimed Restitution Application printable pdf download

INDIVIDUAL VICTIM APPLICATION AND INSTRUCTIONS

UNCLAIMED RESTITUTION APPLICATION

INSTRUCTIONS

The Unclaimed Restitution Program: When an offender

is sentenced in court, part of their sentence may include

To expedite the processing of your application, please

paying restitution (money) back to the victim of the crime.

submit a complete Individual Victim Unclaimed Restitution

When money is unclaimed by a victim or business for

Application Packet, which includes items 1 thru 3 below.

more than two years, it is transferred to the Crime Victims

Emergency Fund. At that time, the Unclaimed Restitution

Program makes attempts to locate and contact the victim

or business.

Please complete the entire application, printing clearly.

This application is for individual victims of crime who

Sign where required and have your signature notarized.

have unclaimed court ordered restitution funds. If

your business experienced a criminal act resulting in

restitution being ordered, please visit our website,

crimevictimscomp.ga.gov, to download the Business

Unclaimed Restitution Application.

Please provide us with a copy of your Driver’s License of

State Identification Card.

PLEASE NOTE

Additional documentation may be requested once

an application has been received and reviewed.

Please complete a request for Taxpayer Identification Number

If you believe you may have money that is owed

and Certification Form (W-9 Form), which can be found on

to you as a result of a crime against you or your

our website at crimevictimscomp.ga.gov.

business, you may search our unclaimed restitution

database on our website at:

crimevictimscomp.ga.gov.

Mail the complete application packet to

CRIME VICTIMS COMPENSATION

Criminal Justice Coordinating Council,

Unclaimed Restitution Program

PROGRAM

104 Marietta Street NW, Suite 440

Atlanta, GA 30303

In addition to the Unclaimed Restitution, you or

your family members may also be eligible for other

expenses related to the victimization. The Crime Victims

If you would like help completing your application, or if you

Compensation Program may be able to help ease the

financial burden and assist with expenses to include the

have questions, please call us. We have Unclaimed Restitution

following:

Specialists available to assist you.

BENEFIT CATEGORIES

Office: (404) 657-2222

Toll Free: (800) 547-0060

Medical Expenses . . . . . . . . . . . . . . . . Up to $15,000

TTY: (404) 463-7650

Funeral Expenses . . . . . . . . . . . . . . . . . Up to $6,000

Fax: (404) 463-7652

Counseling Expenses . . . . . . . . . . . . . . Up to $3,000

crimevictimscomp .ga .gov

Economic Support Expenses . . . . . . . . Up to $10,000

Crime Scene Sanitization Expenses . . . Up to $1,500

According to Georgia State Statute O.C.G.A. §17-14-18 which states in part,

“If a person or entity entitled to restitution cannot be located.., the restitution

paid to such person or entity shall be deposited in the Crime Victims Emergency

Fund... a person or entity entitled to such restitution may claim such restitution...

by applying in writing to Georgia Crime Victims Compensation Board. Upon

receipt of such application and verification that the person making the claim is in

fact entitled to such restitution, the Georgia Crime Victims Compensation Board

shall pay such restitution to the person or entity.” (The complete Georgia Code

can be found at ).

Unclaimed Restitution Application

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