Amador County, CA · Amador County
Claim Against the County
This claim form is for people seeking compensation from Amador County for an accident, injury, or loss involving the county.
At a glance
- Issued by
- City of Amador County · Amador County, Amador County, California
- Notarization
- Not required: file this form without a notary.
- Official source
- amadorcounty.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
Use this form to present a claim against Amador County for an accident, injury, or loss. It asks for the claimant’s contact details, the incident date and location, the basis of the claim, and an itemized list of expenses or damages. The form also requests a description of what happened and names and phone numbers for involved county employees and witnesses; estimates, receipts, and an available police report may be attached.
Who needs it
Anyone filing a claim against Amador County for an accident, injury, or loss should complete and sign this form.
How to submit it
File the signed claim in person or by mail with the Clerk of the Board of Supervisors at 810 Court Street, Jackson, CA 95642, or email it to [email protected].
About notarization
This document is signed and dated without a notary; it does not identify any attachment or related step that must be notarized or sworn.
How to submit this form
- 1
Download the Claim Form
Download the Claim Against the County form.
- 2
Complete the Form
Provide claimant details, incident information, the basis of the claim, expenses or damages, and a description of what happened.
- 3
Gather Attachments
Attach estimates and receipts; include a police report if available. The form specifies one estimate under $1,000 and two for amounts over $1,000.
- 4
Sign and Submit
Sign and date the claim, then file it in person, by mail, or by email with the Clerk of the Board of Supervisors.
Frequently asked questions
- Do I need a notary for the Claim Against the County?
- No. The form calls for the claimant or representative to sign and date it, without a notary. It does not identify any attachment or related step that must be notarized or sworn.
- How do I submit the Claim Against the County?
- File the signed form in person or by mail with the Clerk of the Board of Supervisors at 810 Court Street, Jackson, CA 95642, or email it to [email protected].
- What information does the claim form request?
- It asks for claimant contact information, incident details, the basis of the claim, itemized expenses or damages, and a description of the event and claimed loss.
- What should I attach to the claim?
- Attach any estimates and receipts. The form requests one estimate for repairs or damages under $1,000, two estimates for amounts over $1,000, and a police report if available.