Restitution Request Form [PDF]

If you are a victim of crime in which you may have suffered personal injury or loss, you may be eligible for payment for some or all of your loss.  Reimbursement for the actual costs of physical damage, property damage, or medical bills is called “restitution”.  Medical expenses due to personal injury are also considered restitution.  Pain and suffering cannot be allowed as restitution on a criminal matter. Counseling costs may only be ordered in cases with an adult defendant.

It is possible that property that was stolen/damaged has been returned or is being held as evidence.  Because of this, we need you to provide us with the amount of actual loss.  If you are unsure if items were recovered contact the police agency with which you originally reported the crime.  We do not use the police report to determine restitution unless a victim makes that request in writing to the Victim/Witness Office.  We require you send us this information within ten business days of the matter being charged criminally.   If you have any questions after reading the instruction below, please contact (715) 726-7968.

 INFORMATION NEEDED TO DETERMINE LOSS

PROPERTY:

                Prepare an itemized listing of your loss.

      Provide an estimate of cost of repair or replacement.

PERSONAL  INJURY:                    

                Submit itemized list of all medical expenses.

ALWAYS PROVIDE COPIES OF RECEIPTS, REPAIR ORDERS, AND MEDICAL BILLS WHEN POSSIBLE

 INSURANCE:

If you have insurance covering all or part of your loss, provide: name of insurance company, their address, policy number, phone number, and amount of your deductible. 

 NO INSURANCE:

You are then responsible for paying your bills, but you may be able to obtain reimbursement through court ordered restitution.

The State of Wisconsin has a Crime Victim Compensation Program to reimburse victims who have lost wages or must pay medical expenses as the result of being a crime victim and who do not have any other means of paying their bills. This program does NOT cover property loss.  Please contact Victim/Witness Services if you need a Crime Victim Compensation Application. You may also apply for Crime Victim Compensation online at https://www.doj.state.wi.us/ocvs/compensation/apply-crime-victim-compensation.

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