Objection/statement Of Interest Form

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OMB Number 1105-0077
U.S. Department of Justice
Victim Compensation Fund
P. O. Box 18698
Washington, D.C. 20036-8698
Dear Objector:
In order for us to be able to evaluate your objection or statement of interest, please complete the
information requested in the attached Objection/Statement of Interest Form, sign it, make a copy
for your files, and mail the original signed form to the address shown above. Please send your
objection/statement of interest to us as soon as possible so it may be considered. Please use
the Objection/Statement of Interest Form below to facilitate this process. If your form is not sent
to us in a timely manner, the claim you are objecting to or have an interest in may be processed
before we receive your form, which at that time it will be withdrawn from consideration.
Before you complete the Objection/Statement of Interest Form, you should be aware of the
following important points. Please read these carefully before you decide how you wish to
proceed:
• First, only one claim is to be submitted on behalf of a deceased victim, and that claim is to
be submitted by the person determined by the Special Master to be the “Personal
Representative.”
The Special Master believes that, in most cases, this person should normally be the
individual appointed by a court as the “executor” or “administrator” or the “Personal
Representative” of the decedent’s will or estate. In certain instances, the Special Master does
have discretion to designate the Personal Representative if the applicant is the person named
in the decedent’s will as the executor or administrator, or if the applicant is the first person in
the line of succession established by the laws of the state of the decedent’s domicile if the
victim died without a will.
• Second, the Personal Representative who files a claim on behalf of a deceased victim is not
necessarily the person who is entitled to the award. Rather, the Personal Representative is
under an obligation to distribute the award in a manner consistent with the law of the
decedent’s domicile or any applicable ruling made by a court of competent jurisdiction or as
provided by the Special Master. For example, a surviving spouse appointed by a State court
as Administrator of the estate may be the Personal Representative who submits a single claim
under the Fund, but he or she is required to distribute any award to any other relatives or
beneficiaries entitled to receive part of the award. In some cases, the Special Master may
make provision for separate distributions to comply with an approved distribution plan. An
example would be payments to a minor.
• Third, the regulations provide that the Personal Representative shall provide to the Special
Master a plan for distribution of any award received from the Fund before final payment is
authorized. Any third party may provide a suggestion regarding the distribution plan.
In the event the Special Master concludes that the Personal Representative’s plan for
distribution does not appropriately compensate the victim’s spouse, children, or other
relatives, the Special Master may direct the Personal Representative to distribute all or part
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