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Crime Victims Compensation Board Complaints Logging
Complaint Details
Date of Incident (if relevant):
Name of person or entity claim is made against:
*
Type of group reporting about:
The county where the incident occured:
*
Location of Incident:
Summary of Complaint (describe your complaint):
*
Complainant Details

This Section is Optional and is Not Required

I wish to submit this anonymously:
It is ok to contact me if more details are needed.
Contact me method:
Name:
Address:
City:
State:
Zip:
County:
Daytime Phone Number:
Email Address:
Contact Comments
Attestation

By submitting this form, I am attesting that this information is submitted truthfully, to the best of my knowledge. I understand and accept that this is a serious charge and that this is not submitted in a frivolous or malicious manner.

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