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ÀÛ¼ºÀÏ:06.19.19

 

ÀúÈñ°¡ ÆøÇà»ç°Ç¿¡ ¿¬·ùµÇ¾î Àú¹øÁÖ¿¡ »ó´ë¹Ý ÀçÆÇÀÌ ÀÖ¾ú½À´Ï´Ù.
»ó´ë¹æÀÌ ¸ðµç°É ÀÎÁ¤ Çß°í °Ë»ç´Â ÀúÈñÇÑÅ× º¸»ó¿¡ ´ëÇÑ ¸ÞÀÏÀ» º¸³»¿ÔÀ¾´Ï´Ù.
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Los stolen and/or damaged property (repair or replacement costs; estimates acceptable. if your insurance, include full replacement value/ repair cost, not just insurance deductible.)

Medical expenses:(include any explanation of the benefits paid by medical insurance, medi-cal or medicare. If you do not have medical insurance, medi-cal or medicare, include provider bill)
ÀÌ°Ç º¸Çè Ä¿¹öµÈ ±Ý¾×À» Àû¾î¾ß Çϳª¿ä ¾Æ´Ô Àüü ±Ý¾×À» ½á¾ß Çϳª¿ä?

Wage loss:(please provide copy of pay stubs, payroll records or other of wage loss.) pay syubs Àº ¾ðÁ¦°É º¸³»¾ß Çϳª¿ä.

Additional loss: (Examples of other types of loses that can be claimed are mental mental health counseling, relocation expenses, residential security expenses, attorney¡¯s fees, loss profits, or other crime –related expenses.)Á¤½ÅÀû »ó´ãÀº ¹ÞÀºÀûÀº ¾øÁö¸¸ Á¤½ÅÀû ÇÇÇØ º¸»ó ±Ý¾×À» Àû¾îµµ µÇ³ª¿ä.. ¾Æ´Ï¸é Áö±ÝÀÌ¶óµµ »ó´ã ¹Þ¾Æµµ µÇ³ª¿ä. ÀúÈñ°¡ ½Ã°£ÀÌ ¾ø¾î¼­ º´¿øÀ» ´Ù´ÏÁö´Â ¸øÇß¾î¿ä.

Did the juvenile offender or defendant¡¯s insurance pay for any loss? (include the name of the person insured and the type of loss that the insurance covered. And correspondence or documents from an insurance company that show how much was paid and for what purpose should be attached to this form.)
¿©·¯°¡Áö ÀÚ¼¼ ÇÏ°Ô Á» ¾Ë·Á ÁÖ¼¼¿ä.

(Àü¹®°¡: Äɺó Àå | ÀÛ¼º½Ã°£:06.26.19)
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