allahassee, FL 3230-1050 . Office: (800)2264687 Fax: (853) 414.6191 Bill Status Inform:tier for Providers 050) 414-3331 • TDD users may call through Florida Relay Service at 1.803.9558771 'Nebsite: myfloridalegalcom • Email address: [email protected] BUREAU OF VICTIM COMPENSATION CLAIM FORM Instructions P

allahassee, FL 3230-1050 . Office: (800)2264687 Fax: (853) 414.6191 Bill Status Inform:tier for Providers 050) 414-3331 • TDD users may call through Florida Relay Service at 1.803.9558771 'Nebsite: myfloridalegalcom • Email address: [email protected] BUREAU OF VICTIM COMPENSATION CLAIM FORM Instructions P

allahassee, FL 3230-1050 . Office: (800)2264687 Fax: (853) 414.6191 Bill Status Inform:tier for Providers 050) 414-3331 • TDD users may call through Florida Relay Service at 1.803.9558771 'Nebsite: myfloridalegalcom • Email address: [email protected] BUREAU OF VICTIM COMPENSATION CLAIM FORM Instructions P

0; (800) 955-8771 (TDD) or (800) 955-8770 (V) via Florida Relay Service If you are hearing or voice impaired, call 711.

Cour!. 205 Noah Dixie High. voQy, Room 5,25, West Palo. Beach, Ronde 33401, telephone (eel) 455-2431, 1.800.955-8771 (WD) or 1200-95545770 (V). via Florida Relay Service'. 07/26/17 Page 71 of 104 Public Records Request No.: 17-295 DATE: 1 0 ./1-'-4 E KRISC11ER thtniry A33iSialifit State Atteme Florida Bar S