Lassen County, CA · Lassen County
Claim for Damages
This form lets a person submit a claim to Lassen County for injury, property damage, or loss resulting from an accident, event, or transaction.
At a glance
- Issued by
- City of Lassen County · Lassen County, Lassen County, California
- Notarization
- Not required: file this form without a notary.
- Official source
- lassencounty.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 damages claim to Lassen County for an injury, property damage, or loss connected to an accident, event, or transaction. It asks for the occurrence details, alleged county act or omission, injuries or property damage, witnesses, supporting cost records, and, for vehicle claims, insurance and vehicle information. The form states the claim must be filed with the Clerk of the Board of Supervisors within six months.
Who needs it
Anyone submitting a claim to Lassen County for injury, property damage, or loss should complete this form and provide the requested supporting information.
How to submit it
Mail the completed claim to the Lassen County Clerk of the Board, 220 S Lassen St, Ste 5, Susanville, CA 96130. The form states it must be filed within six months after the accident or event.
About notarization
This document does not require notarization; the claimant signs and dates it and certifies under penalty of perjury that the statements are true and correct.
How to submit this form
- 1
Download the Form
Download the Claim for Damages form.
- 2
Complete the Claim
Provide the requested claimant, occurrence, injury or property damage, witness, and damages information.
- 3
Gather Supporting Papers
Attach supporting bills, receipts, or estimates of cost; include additional paper if space is insufficient and identify information by paragraph number.
- 4
Mail the Claim
Mail it to the Lassen County Clerk of the Board at 220 S Lassen St, Ste 5, Susanville, CA 96130, within six months after the accident or event.
Frequently asked questions
- Do I need a notary for a Claim for Damages?
- No. The claim is signed and dated without a notary. The claimant certifies under penalty of perjury that the statements are true and correct.
- How do I submit a Claim for Damages?
- Mail the completed claim to the Lassen County Clerk of the Board at 220 S Lassen St, Ste 5, Susanville, CA 96130.
- When must I file the claim?
- The form states that the claim must be filed with the Clerk of the Board of Supervisors within six months after the accident or event.
- What information does the claim request?
- It requests details about the event, alleged cause, injury or property damage, witnesses, damages and supporting records. Vehicle claims also require insurance and vehicle information.