This government document is issued by Governor's Office of Crime Control and Prevention for use in Maryland
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https://www.google.com/url?client=internal-element-cse&cx=007821330218074952993:_zvwwdtcp6g&q=http://goccp.maryland.gov/wp-content/uploads/gov-victim-assistance-award-nomination-form-2018.pdf&sa=U&ved=2ahUKEwjR_NaKgI_xAhVMzBoKHT0OBmo4RhAWMAF6BAgAEAI&usg=AOvVaw2GAyU8FGL-PhUt2PuwjwXJ