Mesa, AZ · Maricopa County
City Claim Form
The City Claim Form lets a person or entity submit a potential claim to the City of Mesa and describe the incident, claimed damages, and supporting evidence.
What this form is
Use this form to register a potential claim against the City of Mesa. It asks for claimant and incident details, witnesses, injury and treatment information, the amount sought, supporting documents, and a signed certification. The form says claims must be filed with the City Clerk within 180 days after the claim accrues; filing does not guarantee payment, settlement, or reimbursement.
Who needs it
A person or entity with a potential claim against the City of Mesa can use this form to register the claim with the City Clerk.
How to submit it
File with the Office of the City Clerk within 180 days after the claim accrues: in person at 20 E. Main Street, Suite 150, Mesa, AZ 85201; by mail to PO Box 1466, MS-1003, Mesa, AZ 85211-1466; or by email to [email protected].
About notarization
This form is signed and dated without a notary; it requires the claimant or authorized representative to certify that the information is true and correct.
How to submit this form
- 1
Download The Form
Download the City Claim Form PDF.
- 2
Complete The Claim Details
Provide claimant and incident information, describe why you believe the City was at fault, and complete the injury and amount sections if applicable.
- 3
Gather Supporting Documents
Attach relevant estimates, bills, receipts, photos, and witness statements. Submit documents and photos as PDFs and videos as MP4 files.
- 4
Sign And Submit
Sign and date the form, then file it with the Office of the City Clerk within 180 days after the claim accrues.
Frequently asked questions
- Do I need a notary for the City Claim Form?
- No. The form calls for the claimant or an authorized representative to sign and date a certification; it does not require notarization.
- How do I submit the City Claim Form?
- File it with the Office of the City Clerk in person, by mail, or by email, using the contact details printed on the form.
- What should I include with the claim?
- The form requests supporting documents such as estimates, bills, receipts, photos, and witness statements. Documents and photos must be PDF files; videos must be MP4 files.
- When must I file a claim?
- The form says a claim must be filed with the Mesa City Clerk within 180 days after the claim accrues.
Need something notarized?
This City Claim Form doesn’t need a notary — but if you have another Mesa form that does, a commissioned online notary can help.