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104 Marietta Street Suite 440 - Atlanta GA 30303 Office 404 657-2222 - Fax 404 463-7652 Website crimevictimscomp.ga.gov MINOR BENEFICIARY FORM To apply for counseling and/or economic support benefits on the behalf of the deceased victim s minor child ren or minor sibling s please complete this form as the custodial parent/legal guardian. Please Note Proof of relationship and/or guardianship must be submitted with this form i.e. birth certificate marriage license guardianship papers etc.....

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