EFTA00006055.pdf
5.75 MB
Extraction Summary
2
People
6
Organizations
4
Locations
2
Events
1
Relationships
3
Quotes
Document Information
Type:
Victim compensation claim form and informational brochures
File Size:
5.75 MB
Summary
This document contains informational brochures for Palm Beach County Victim Services and the Center for Trauma Counseling, followed by a Florida Bureau of Victim Compensation Claim Form. The form was filled out by a female victim (name redacted) residing in North Palm Beach who works in retail management. She signed the form on October 25, 2019, requesting compensation for expenses and wage loss, noting she is represented by legal counsel.
People (2)
| Name | Role | Context |
|---|---|---|
| [Redacted] | Victim/Applicant |
Person filing for victim compensation; lives in North Palm Beach, FL; works in Retail Management; Female; USA origin.
|
| [Redacted] | Attorney |
Legal counsel representing the victim (name redacted).
|
Organizations (6)
| Name | Type | Context |
|---|---|---|
| Palm Beach County Victim Services |
Provider of services listed in brochure
|
|
| Public Safety Department Victim Services Division |
Palm Beach County department
|
|
| Office of the Attorney General |
Florida state office processing the claim
|
|
| Bureau of Victim Compensation |
Specific bureau handling the claim
|
|
| Center for Trauma Counseling, Inc. |
Non-profit community counseling center listed on flyer
|
|
| Blue Cross Blue Shield |
Victim's insurance provider
|
Locations (4)
| Location | Context |
|---|---|
|
Victim's residence city and zip code
|
|
|
Main Courthouse address
|
|
|
Victim Services SART Center address
|
|
|
Center for Trauma Counseling address
|
Relationships (1)
Victim [Redacted]
→
Legal Representation
→
Attorney [Redacted]
Section 6 check box 'ARE YOU REPRESENTED BY LEGAL COUNSEL? YES'
Full Extracted Text
Complete text extracted from the document (4,571 characters)
Vision Justice for all crime victims.
Mission Statement With compassion and respect, we assist victims of sexual assault, domestic violence, homicide, and other violent crimes through crisis response, advocacy, therapy, and community awareness.
Palm Beach County Victim Services is a Certified Rape Crisis Center that provides therapy services to all crime victims in Palm Beach County regardless of the victims' race, sex, color, religion, national origin, disability, sexual orientation, marital status, familial status or gender identity or expression.
Start by Believing: A Public Awareness Campaign to Change the Way We Respond to Sexual Violence in Our Community... one response at a time. YOUR REACTION MAKES THE DIFFERENCE. When someone tells you they've been raped, there's a simple response. Start by Believing.
Palm Beach County Public Safety Department Victim Services Division
www.pbcgov.com/publicsafety/victimservices
24/7 SEXUAL ASSAULT VIOLENT CRIME HELPLINE: (561) 833-7273
TOLL FREE: (866) 891-7273
Main Courthouse 205 North Dixie Hwy., Suite 5.1100 West Palm Beach, FL 33401 (561) 355-2418 option 3 TTY: (561) 233-2595
Victim Services SART Center 4210 North Australian Ave. West Palm Beach, FL 33407 (561) 625-2568 option 1 TTY: (561) 624-6520
North County Courthouse 3188 PGA Blvd., Suite 1436 Palm Beach Gardens, FL 33410 (561) 355-2418 option 3 TTY: (561) 624-6643
South County Courthouse 200 West Atlantic Ave., Suite 1E-301 Delray Beach, FL 33444 (561) 274-1500 TTY: (561) 274-1015
West County-Glades Courthouse 2976 State Road 15, 2nd Floor Belle Glade, FL 33430 (561) 996-4871 TTY: (561) 992-1113
Like Us on PBCVictimServices
Services are funded through Palm Beach County Board of County Commissioners with grants from the Office of the Attorney General and Florida Council Against Sexual Violence.
Have You Been A Victim Of A Crime? Do You Experience Any Of The Following? Inability to fall or stay asleep? Feeling anxious or depressed? Having outbursts of anger? Inability to concentrate? Feeling emotionally numb? Loss of interest in the things you used to enjoy? Painful memories of the traumatic event? Bad dreams about the traumatic event? Flashbacks or a sense of reliving the events? Racing thoughts? Physiological stress response to reminders of the event? (pounding heart, rapid breathing, nausea, muscle tension, sweating)
Palm Beach County provides equality of services and care to everyone... Services Provided Free services include individual therapy for children and adults and adult-support groups. If you are a crime victim or have been a victim of crime in the past and are considering therapy, we welcome your call.
Therapy For Children & Teenagers... Signs Of Trauma In Children...
Florida Statute 960 Provides Guidelines For Fair Treatment & Specific Rights For Victims In The Criminal Justice System...
Center for Trauma Counseling Where Your Emotional Healing Can Begin A non-profit Community Counseling Center Serving Palm Beach County and beyond... 6801 Lake Worth Road, Suite 307 Greenacres, FL 33467 Office: 561-444-3914
Office of the Attorney General BUREAU OF VICTIM COMPENSATION CLAIM FORM
Instructions: Please read the Eligibility Requirements...
CHECK THE TYPE OF VICTIM COMPENSATION BENEFITS YOU ARE REQUESTING:
[Checked] EXPENSES - payment or reimbursement on behalf of the victim for crime-related funeral/burial, medical/dental treatment, and mental health counseling expenses...
[Checked] WAGE LOSS - compensation for the victim who lost wages due to crime related physical injuries.
Section 1. Victim and Applicant Information
VICTIM'S NAME: [Redacted]
SOCIAL SECURITY NO.: [Redacted]
E-MAIL ADDRESS: [Redacted]
WOULD YOU LIKE ALL CORRESPONDENCE SENT BY EMAIL? [Checked] YES
ADDRESS: [Redacted]
CITY: North Palm Beach
STATE: FL
ZIP CODE: 33408
TELEPHONE NUMBER: [Redacted]
OCCUPATION: Retail management
RACE/ETHNICITY: [Checked] WHITE NON-LATINO/CAUSCASIAN
GENDER: [Checked] Female
NATIONAL ORIGIN: USA
WAS VICTIM DISABLED BEFORE THE CRIME OCCURRED? [Checked] NO
APPLICANT NAME: [Redacted/Same as Victim implied]
Section 5. Insurance Information
1. COMPANY NAME: Blue Cross Blue Shield
TELEPHONE NUMBER: (1-800) 275-2583
Section 6. Other Compensation, Settlement, and Attorney Information
DATE RECEIVED (IF APPLICABLE): 10/15/19
ARE YOU REPRESENTED BY LEGAL COUNSEL? [Checked] YES
ATTORNEY'S NAME: [Redacted]
Section 9. CONFIDENTIALITY... [Checked] I want the information to be confidential
VICTIM: Must be signed and dated by the victim if filing as a competent adult.
Signature: [Redacted]
Date: 10/25/19
Mission Statement With compassion and respect, we assist victims of sexual assault, domestic violence, homicide, and other violent crimes through crisis response, advocacy, therapy, and community awareness.
Palm Beach County Victim Services is a Certified Rape Crisis Center that provides therapy services to all crime victims in Palm Beach County regardless of the victims' race, sex, color, religion, national origin, disability, sexual orientation, marital status, familial status or gender identity or expression.
Start by Believing: A Public Awareness Campaign to Change the Way We Respond to Sexual Violence in Our Community... one response at a time. YOUR REACTION MAKES THE DIFFERENCE. When someone tells you they've been raped, there's a simple response. Start by Believing.
Palm Beach County Public Safety Department Victim Services Division
www.pbcgov.com/publicsafety/victimservices
24/7 SEXUAL ASSAULT VIOLENT CRIME HELPLINE: (561) 833-7273
TOLL FREE: (866) 891-7273
Main Courthouse 205 North Dixie Hwy., Suite 5.1100 West Palm Beach, FL 33401 (561) 355-2418 option 3 TTY: (561) 233-2595
Victim Services SART Center 4210 North Australian Ave. West Palm Beach, FL 33407 (561) 625-2568 option 1 TTY: (561) 624-6520
North County Courthouse 3188 PGA Blvd., Suite 1436 Palm Beach Gardens, FL 33410 (561) 355-2418 option 3 TTY: (561) 624-6643
South County Courthouse 200 West Atlantic Ave., Suite 1E-301 Delray Beach, FL 33444 (561) 274-1500 TTY: (561) 274-1015
West County-Glades Courthouse 2976 State Road 15, 2nd Floor Belle Glade, FL 33430 (561) 996-4871 TTY: (561) 992-1113
Like Us on PBCVictimServices
Services are funded through Palm Beach County Board of County Commissioners with grants from the Office of the Attorney General and Florida Council Against Sexual Violence.
Have You Been A Victim Of A Crime? Do You Experience Any Of The Following? Inability to fall or stay asleep? Feeling anxious or depressed? Having outbursts of anger? Inability to concentrate? Feeling emotionally numb? Loss of interest in the things you used to enjoy? Painful memories of the traumatic event? Bad dreams about the traumatic event? Flashbacks or a sense of reliving the events? Racing thoughts? Physiological stress response to reminders of the event? (pounding heart, rapid breathing, nausea, muscle tension, sweating)
Palm Beach County provides equality of services and care to everyone... Services Provided Free services include individual therapy for children and adults and adult-support groups. If you are a crime victim or have been a victim of crime in the past and are considering therapy, we welcome your call.
Therapy For Children & Teenagers... Signs Of Trauma In Children...
Florida Statute 960 Provides Guidelines For Fair Treatment & Specific Rights For Victims In The Criminal Justice System...
Center for Trauma Counseling Where Your Emotional Healing Can Begin A non-profit Community Counseling Center Serving Palm Beach County and beyond... 6801 Lake Worth Road, Suite 307 Greenacres, FL 33467 Office: 561-444-3914
Office of the Attorney General BUREAU OF VICTIM COMPENSATION CLAIM FORM
Instructions: Please read the Eligibility Requirements...
CHECK THE TYPE OF VICTIM COMPENSATION BENEFITS YOU ARE REQUESTING:
[Checked] EXPENSES - payment or reimbursement on behalf of the victim for crime-related funeral/burial, medical/dental treatment, and mental health counseling expenses...
[Checked] WAGE LOSS - compensation for the victim who lost wages due to crime related physical injuries.
Section 1. Victim and Applicant Information
VICTIM'S NAME: [Redacted]
SOCIAL SECURITY NO.: [Redacted]
E-MAIL ADDRESS: [Redacted]
WOULD YOU LIKE ALL CORRESPONDENCE SENT BY EMAIL? [Checked] YES
ADDRESS: [Redacted]
CITY: North Palm Beach
STATE: FL
ZIP CODE: 33408
TELEPHONE NUMBER: [Redacted]
OCCUPATION: Retail management
RACE/ETHNICITY: [Checked] WHITE NON-LATINO/CAUSCASIAN
GENDER: [Checked] Female
NATIONAL ORIGIN: USA
WAS VICTIM DISABLED BEFORE THE CRIME OCCURRED? [Checked] NO
APPLICANT NAME: [Redacted/Same as Victim implied]
Section 5. Insurance Information
1. COMPANY NAME: Blue Cross Blue Shield
TELEPHONE NUMBER: (1-800) 275-2583
Section 6. Other Compensation, Settlement, and Attorney Information
DATE RECEIVED (IF APPLICABLE): 10/15/19
ARE YOU REPRESENTED BY LEGAL COUNSEL? [Checked] YES
ATTORNEY'S NAME: [Redacted]
Section 9. CONFIDENTIALITY... [Checked] I want the information to be confidential
VICTIM: Must be signed and dated by the victim if filing as a competent adult.
Signature: [Redacted]
Date: 10/25/19
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