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Phone is 17 Victim/Claimant's Authorization: I ACKNOWLEDGE that accepting an award from the Office of Victim Sented (OVS) creates a hen m favor of the State of New York on any recovery relating to the crime upon which this dam is based. inducting any Judgment settlement or order of restitution. I further authorize a
tion because of the release or disclosure of HIV-related information. I may contact the New York State Division of Human Rights at (212) 480-2493 or the New York City Commission of Human Rights at (212) 306.7450. These agencies are responsible for protecting my rights. 3 I have the right to revoke this authorization at any time by writing
2 mentions1 same-page
Page ?Same page
s Phone it 17 Victim/Claimant's Authorization: I ACKNOWLEDGE that auxpting an award from me Mee or victim services (OVS) aeates a hen in favor of the State of New York on any recovery relating to the crime upon which this claim is based, including any judgment, settlement or order of restitution. I further authoriz
ation because of the release or disclosure of WV-related information, i may contact the New York State Division of Human Rights at (212) 480-2493 or the New York City Commission of Human Rights at (212) 306-7450. These agencies are responsible for protecting my rights. 3. I have the right to revoke this authorization at any time by writing
2 mentions
Page EFTA00038441
ne # 17 Victim/Claimant's Authorization: I ACKNOWLEDGE that accepting an award from the Office of Victim Services (OVS) creates a lien in favor of the State of New York on any recovery relating to the crime upon which this claim is based, including any judgment, settlement or order of restitution. I further authoriz
Page: EFTA00038441 →Page EFTA00038442
tion because of the release or disclosure of HIV-related information, I may contact the New York State Division of Human Rights at (212) 480.2493 or the New York City Commission of Human Rights at (212) 306-7450. These agencies arc responsible for protecting my rights. 3. 1 have the right to revoke this authorization at any time by writing
Page: EFTA00038442 →Sponsored
Mutual Connections (20)
Entities connected to both the State of New York and the New York City Commission of Human Rights
New York State
LOCATION51 w/ the·2 w/ the
Albany
LOCATION33 w/ the·4 w/ the
Medicaid
ORGANIZATION2 w/ the·3 w/ the
New York State Law
ORGANIZATION2 w/ the·3 w/ the
HIPAA
ORGANIZATION2 w/ the·3 w/ the
See the Court Ordered Restitution Information
ORGANIZATION2 w/ the·2 w/ the
First Hospital
ORGANIZATION2 w/ the·2 w/ the
the New York State Department of Health'
ORGANIZATION2 w/ the·2 w/ the
the Social Security Death Benefit
ORGANIZATION2 w/ the·2 w/ the
S. Swan
ORGANIZATION2 w/ the·2 w/ the
OVictim Assistance Program
ORGANIZATION2 w/ the·2 w/ the
Disability Insurance
ORGANIZATION2 w/ the·2 w/ the
the Death Certificate
ORGANIZATION2 w/ the·2 w/ the
Primary Insurance Company
ORGANIZATION2 w/ the·2 w/ the
Governmental Agency Name
ORGANIZATION2 w/ the·2 w/ the
The New York State Public Health Law
ORGANIZATION2 w/ the·2 w/ the
Victim Services
ORGANIZATION2 w/ the·2 w/ the
STATE Office of
ORGANIZATION2 w/ the·2 w/ the
Social Security Benefits
ORGANIZATION2 w/ the·2 w/ the
CA
Complete Address
PERSON2 w/ the·2 w/ the