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Cvrc.state. nm.us REVISED 2/2017 Phone 505-841-9432 Fax 505-841-9437 Web www. cvrc.state. nm.us COMMISSION APPLICATION DO NOT USE PENCIL Section 1. This release is in compliance with all HIPPA regulations. VICTIM Printed Name Signature Date CLAIMANT. CLAIMANT INFORMATION Relationship to Victim Spouse Parent Sibling Child Grandparent Friend Other Section 3. Information is provided my application for compensation may be denied and I may be subject to criminal punishment pursuant to NMSA...
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The purpose of the cvrc-app-feb2017 final - crime form is to collect and report crime data for statistical analysis and law enforcement purposes.
Information such as type of crime, location, date and time, and details of the incident must be reported on the cvrc-app-feb2017 final - crime form.
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