Richmond, CA · Contra Costa County
Claim Form Against Housing Authority
This form lets people submit a claim to the Richmond Housing Authority for alleged injury or damage and provide details supporting the claim.
What this form is
Use this form to present a claim against the Richmond Housing Authority for alleged injury or damage. It asks for the claimant’s contact information, incident details, claimed losses and their computation, witnesses, and relevant medical providers; the claimant must sign and date it. The instructions describe different presentation periods for certain types of claims and say incomplete forms may be returned as insufficient.
Who needs it
Anyone seeking to present a claim against the Richmond Housing Authority for alleged injury or damage should complete and sign this form.
How to submit it
Send all original copies to Housing Authority Claims, Attention: City Clerk’s Office, 450 Civic Center Plaza, 3rd Floor, Richmond, CA 94804. The form lists (510) 620-6513, Ext. 9.
About notarization
This claim is signed without a notary; the claimant also declares under penalty of perjury that the information is true and correct.
How to submit this form
- 1
Download The Claim Form
Download the Richmond Housing Authority claim form PDF.
- 2
Complete Every Section
Type or print clearly, provide the requested claim details, and complete each section.
- 3
Gather Supporting Copies
If available, attach copies of bills, payment receipts, and cost estimates; make a copy of the completed form for your records.
- 4
Sign And Submit The Form
Sign and date the claim, then send all original copies to the City Clerk’s Office at the address listed on the form.
Frequently asked questions
- Do I need a notary for the Housing Authority claim form?
- No. The form has no notary block; the claimant signs and dates it and declares under penalty of perjury that the information is true and correct.
- How do I submit the Housing Authority claim form?
- Send all original copies to Housing Authority Claims, Attention: City Clerk’s Office, 450 Civic Center Plaza, 3rd Floor, Richmond, CA 94804.
- What information does the claim form request?
- It requests claimant contact details, where and when the incident occurred, circumstances and claimed damage or injury, witnesses, and relevant doctors or hospitals.
- What should I attach to the claim?
- The instructions say to attach copies of bills, payment receipts, and cost estimates if available. Claimants should make their own copies for their records.
Need something notarized?
This Claim Form Against Housing Authority doesn’t need a notary — but if you have another Richmond form that does, a commissioned online notary can help.