"Essential Personal Property Verification Form" - New York

Essential Personal Property Verification Form is a legal document that was released by the New York State Office of Victim Services - a government authority operating within New York.

Form Details:

  • The latest edition currently provided by the New York State Office of Victim Services;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the New York State Office of Victim Services.

ADVERTISEMENT
ADVERTISEMENT

Download "Essential Personal Property Verification Form" - New York

415 times
Rate (4.6 / 5) 25 votes
ANDREW M. CUOMO
ELIZABETH CRONIN ESQ.
Governor
Director
Claimant Name:
Date:
Claim #:
Crime Date:
Claimant:
Victim:
Essential Personal Property Verification Form
The NYS Office of Victim Services (OVS) is reviewing your claim application. You have requested
reimbursement for Essential Personal Property (EPP) that was not listed on the Police Report.
In order for OVS to consider your request you must confirm that the following property was in fact lost
or damaged as a result of the crime your claim with us is based upon. Please include a copy of the
original receipt or replacement receipt for the item.
Lost, stolen or damaged due to crime
Item Description
Quantity
**Please circle appropriately:
Ex.: “Wallet”
Ex.: “1”
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Please Note: If you require additional space to list property, you may write on the back of this sheet.
NOTICE
It is a crime to knowingly make a false written statement to the Office of Victim Services. Such action
may result in denial of all or part of a claim and/or criminal prosecution.
By signing this form, I confirm that all the information provided is true and correct.
__________________________________________
______________________________
Signature
Date
*EPP-PV*
Alfred E. Smith State Office Building, 80 South Swan Street, Albany, NY 12210 │ 800-247-8035 │ovs.ny.gov
ANDREW M. CUOMO
ELIZABETH CRONIN ESQ.
Governor
Director
Claimant Name:
Date:
Claim #:
Crime Date:
Claimant:
Victim:
Essential Personal Property Verification Form
The NYS Office of Victim Services (OVS) is reviewing your claim application. You have requested
reimbursement for Essential Personal Property (EPP) that was not listed on the Police Report.
In order for OVS to consider your request you must confirm that the following property was in fact lost
or damaged as a result of the crime your claim with us is based upon. Please include a copy of the
original receipt or replacement receipt for the item.
Lost, stolen or damaged due to crime
Item Description
Quantity
**Please circle appropriately:
Ex.: “Wallet”
Ex.: “1”
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Please Note: If you require additional space to list property, you may write on the back of this sheet.
NOTICE
It is a crime to knowingly make a false written statement to the Office of Victim Services. Such action
may result in denial of all or part of a claim and/or criminal prosecution.
By signing this form, I confirm that all the information provided is true and correct.
__________________________________________
______________________________
Signature
Date
*EPP-PV*
Alfred E. Smith State Office Building, 80 South Swan Street, Albany, NY 12210 │ 800-247-8035 │ovs.ny.gov