Tehachapi, CA · Kern County
Claim Form Form B
This form lets a claimant submit a claim against an entity to the City of Tehachapi, describing an incident, resulting losses, and the amount sought.
What this form is
Claim Form Form B records a claim against an entity, including the incident details, injuries or losses, and the amount of money sought. The claimant provides identifying and contact information, explains what the entity or its employee did, and signs and dates the form. The form also allows a representative to provide their name, address, telephone number, and relationship to the claimant.
Who needs it
A person making a claim against an entity can use this form to describe the incident, losses, and amount sought.
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 claim form is signed and dated without a notary; it lists no notarized or sworn attachment, so the claimant or representative just signs and dates it.
How to submit this form
- 1
Download The Form
Download Claim Form Form B for a claim against an entity.
- 2
Complete The Form
Enter claimant and incident details, describe the injuries or losses, explain the amount sought, and sign and date the form.
- 3
Gather Any Additional Details
Use the back of the form or a separate sheet if you need more space to answer the questions.
- 4
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 Claim Form Form B ask for?
- It asks for claimant details, incident dates and location, what caused the loss, injuries or damages, the amount sought and how it was calculated, and a signature.
- Who can sign the claim form?
- The claimant signs and dates the form. If a representative signs, the form asks for the representative's name, address, telephone number, and relationship to the claimant.
- Do I need a notary for Claim Form Form B?
- No. The form has a signature and date line but no notary block, and it lists no notarized or sworn attachment.
- How do I submit Claim Form Form B?
- Submit it to the city department named on the form; check the city website for current contact details.