Queen Creek, AZ · Maricopa County
Notice of Claim Against the City/Town
This form lets a claimant submit a claim against the City/Town or an employee and describe the event, damages, injuries, and witnesses.
What this form is
Use this form to make a claim against the City/Town or an employee. It asks for claimant contact information, details about the occurrence and fault, descriptions and dollar amounts for property damage and injuries, and witness information. The form also requests receipts or other documentation for claimed amounts and medical reports where available.
Who needs it
A person submitting a claim against the City/Town or an employee can use this form to provide details about the event and claimed damages.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed without a notary; the signer verifies the information and dates the signature, and may attach receipts, other claim documentation, and available medical reports.
How to submit this form
- 1
Download The Form
Download the Notice of Claim PDF.
- 2
Complete The Form
Provide claimant information, occurrence details, claimed damages or injuries, witness information, and any additional comments.
- 3
Gather Attachments
Attach receipts or other documentation of claimed amounts and medical reports where available.
- 4
Sign And Date
Sign and date the form to verify the information is true to the best of your knowledge and belief.
- 5
Submit To The City
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- Do I need a notary for the Notice of Claim?
- No. The form calls for a signature and date, not notarization. Attach receipts or other documentation of claimed amounts and medical reports where available.
- What information does the Notice of Claim request?
- It asks for claimant contact details, occurrence information, descriptions and amounts of property damage and injuries, witness details, and any additional comments.
- What should I attach to the Notice of Claim?
- The form asks claimants to attach receipts or other documentation of the amounts claimed and medical reports where available.
- How do I submit the Notice of Claim?
- The form does not provide submission instructions. Submit it to the city department named on the form; check the city website for current contact details.