How do I submit the City of Mesa claim form?

Submit it in person or by mail to the City Clerk’s Office, or email it to clerk.info@mesaaz.gov. Email photos and documents as PDFs and videos as MP4 files; online links are not accepted.

What information does the claim form ask for?

It asks for claimant contact details, incident information, witnesses, injuries and treatment, the exact settlement amount, and supporting documents such as estimates, bills, receipts, photos, and witness statements.

When should I submit a claim?

The form says a claim against the city must be submitted within 180 days from the date of the incident that gives rise to the claim.

Mesa, AZ · Maricopa County

No notary required

Claim Against the City of Mesa

This form lets a person or entity submit a claim against the City of Mesa and provide details about the incident, injuries, witnesses, and requested settlement amount.

What this form is

A person or entity with a claim against the City of Mesa uses this form to report an incident and state why they believe the city was at fault. The form requests contact and incident details, witness information, injury and treatment information, the exact settlement amount, and supporting documents. The instructions say to submit the claim within 180 days of the incident.

Who needs it

A person or entity with a claim against the City of Mesa can use this form to provide incident details and supporting information.

How to submit it

Submit the form to the City Clerk’s Office 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]. Email photos and documents as PDFs and videos as MP4 files; online links are not accepted.

About notarization

This form does not require a notary; the claimant or authorized representative signs and dates the certification that the information is true and correct.

How to submit this form

1
Download The Form
Download the City of Mesa claim form.
2
Complete The Form
Enter claimant and incident details, describe why you believe the city was at fault, list witnesses and treatment information, and state the exact settlement amount.
3
Gather Supporting Documents
Attach copies of supporting documents, such as written estimates, bills, receipts, photos, and witness statements.
4
Submit To The City
Submit in person or by mail to the City Clerk’s Office, or email it to [email protected]. Email photos and documents as PDFs and videos as MP4 files.

Frequently asked questions

Do I need a notary for the City of Mesa claim form?: No. The form does not require a notary; the claimant or authorized representative signs and dates the certification that the information is true and correct.
How do I submit the City of Mesa claim form?: Submit it in person or by mail to the City Clerk’s Office, or email it to [email protected]. Email photos and documents as PDFs and videos as MP4 files; online links are not accepted.
What information does the claim form ask for?: It asks for claimant contact details, incident information, witnesses, injuries and treatment, the exact settlement amount, and supporting documents such as estimates, bills, receipts, photos, and witness statements.
When should I submit a claim?: The form says a claim against the city must be submitted within 180 days from the date of the incident that gives rise to the claim.

Need something notarized?

This Claim Against the City of Mesa doesn’t need a notary — but if you have another Mesa form that does, a commissioned online notary can help.