№ lp_2_3_50096
Administrative authorization form establishing consent for information disclosure, payment arrangements, lien acknowledgment, and certification in connection with a crime victim compensation claim before the Office of Victim Services in New York State.
Jurisdiction: State of New York
Country: United States
Issuing Authority: Office of Victim Services
Document Type: Authorization Form
Subject: Crime victim compensation claim and release of information
Related Programs: Victim Assistance Program (VAP)
Legal Effect: Creation of lien in favor of the State of New York upon recovery related to the crime
Authorization Scope: Release of records and information to OVS, representatives, legal counsel, local government entities, and designated persons
Certification: Declaration of truthfulness under penalty of criminal offense
Signature Requirement: Claimant’s signature and date
Contact Information Required: Daytime phone number and email address
Price: 8 / 10 USD
The file will be delivered to the email address provided at checkout within 12 hours.

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