[Prosecutor's Office Name]
Attn: [Assistant Prosecutor or Victim Services / Restitution Coordinator]
[Street Address]
[City, State ZIP]
[Today's Date]
RE: Restitution Request
| Defendant: [Defendant's Name] Court and Case No.: [Court Name], Case No. [Criminal Case Number] Police Report No.: [Report Number] Victim / Property Owner: [Insured's Name] | Loss Location: [Loss Address] Date of Loss: [Date of Loss] Insurer: [Client Name], Claim No. [Client Claim Number] Amount Requested for Insurer: $[Amount Paid by Client] |
Dear [Name or Restitution Coordinator]:
[Your Company Name] is the recovery agent for [Client Name], which insures [Insured's Name]. On [Date of Loss], property at [Loss Location] was damaged in the incident described in [Police Report Number]. We understand [Defendant's Name] has been charged in the case listed above.
Because of this incident, [Client Name] paid $[Amount Paid by Client] to or on behalf of [Insured's Name] for the damage. We ask that this amount be included in any restitution order entered in this case, payable to [Client Name].
The enclosed documents show each payment. [Insured's Name] also paid a $[Insured's Deductible] deductible and may have other losses that insurance did not cover. Those amounts belong to [Insured's Name] and are not included in our request.
Please let us know:
- The date of the next hearing and the sentencing date
- Whether you need a victim impact statement, an affidavit, or any other form from us
- Where to send any updated payment information
If restitution is ordered, please send payments to the address below, or tell us how the court or probation office will send them.
Payment instructions
Make payment payable to [Client Name], and include claim number [Client Claim Number] and case number [Criminal Case Number].
Mail to: [Your Company Address]
Enclosures
- Itemized list of payments with dates and amounts
- Proof of payment (payment ledger or copies of checks)
- Estimates, invoices, and photographs
- Police or fire report
- Declarations page showing the deductible
Thank you for your help. Please contact me with any questions.
Sincerely,
[Name]
[Title]
[Company]
[Address]
[Phone] · [Email]
cc: [Insured's Name]