4 Tell us about the suspect. Suspects name (If you know) _reier-6-1 cza:11. /hi Has the suspect been arrested for this crime? 0 Yes S . No Has the suspect been prosecuted for this cnme? 0 Yes t g ) No 0 Not Yet Does the suspect live in the same house as the victim OR is the suspect a member of the victims family? 0 Yes g..No Has the court issued an order of protection in this case? 0 Yes ,8No (If Yes, attach a copy ) Has the DA asked the court to order restitution? 0 Yes 0 No 0 Not Yet 7 Did the court order the suspect to pay restitution? 0 Yes (Amount S 1 0 No g Not Yet NOTE - If you are eligible for compensation, the OVS may be able 10 reimburse for the expenses listed below These items should also be requested as part of court ordered restitution Applicants are encouraged to share this information with prosecutors if there is a criminal case See the Court Ordered Restitution Information page for important information about restitution 5 Tell us about your expenses related to this crime. (Check all that apply) O med.caLamboanot 0 Loss of Support DS. Lost Wages Personal Transportation O Cnrne Scene Cleanup (Death Clam Onlyt 0 DV Sheller g mothcaucounsong 2 Security Device/System 0 VocationaLftehabditation EA Moving/Sterne D Court El Counseling 0 Funeral/Burial 0 Essential Personal Property O Other (Explain) — - 6 List any essential personal property, like cash, eyeglasses, or clothing that needs to be replaced because of this crime ill none skip to 7 ) Describe what was lost/damaged Cosi Describe what was lost/damaged Cost 1 $ 4 $ 2._ $ 5 $ S 6 S HomeowneraRenter Insurance Company Policy or Oa DedoctitA $ Auto'Cither Insurance Company Policy or 101 Deductible S — if there were no injuries and you are only asking for essential personal property benefits, skip to 15. — 7 Tell us about the victim's or the parent's employment and insurance for Lost Wages. If you do not want us to contact your em