Mendota, CA · Fresno County
Claim Form
Claimants use this City of Mendota form to describe an incident, injury, damage, or loss and state the amount of money they are seeking.
What this form is
The Claim Form records a claim against an entity and asks for the claimant’s contact details, incident dates and location, and an explanation of what caused the loss, damage, or injury. It also asks claimants to describe their losses, state the amount sought or court jurisdiction, and itemize how the amount was calculated. Use the back of the form or a separate sheet for a detailed explanation if needed.
Who needs it
A person making a claim against an entity for an injury, damage, or loss can use this form to provide the requested claim information.
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 signs and dates it, and any separate sheet used for a detailed explanation is not identified as requiring notarization.
How to submit this form
- 1
Download The Form
Download the City of Mendota Claim Form PDF.
- 2
Complete The Claim Details
Provide claimant and incident information, describe the loss, and state and itemize the amount sought.
- 3
Add A Detailed Explanation If Needed
Use the back of the form or a separate sheet to explain in detail what caused the injury, damage, or loss.
- 4
Sign And Date The Form
Enter the date signed and provide the claimant’s signature; if a representative signs, provide the requested representative details.
- 5
Submit To The City
Submit the form to the city department named on it; check the city website for current contact details.
Frequently asked questions
- What information does the Mendota Claim Form request?
- It requests claimant details, incident dates and location, what caused the injury, damage, or loss, the specific losses, the amount sought or court jurisdiction, and an itemization of the amount.
- Do I need a notary for the Mendota Claim Form?
- No. The form provides spaces for a signature and date, with no notary block. A separate sheet may be used for a detailed explanation, and the form does not identify it as requiring notarization.
- How do I submit the Mendota Claim Form?
- 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.