Azusa, CA · Los Angeles County
Claim Form for Damages to Persons or Personal Property
This form lets people submit a claim to the City of Azusa for death, personal injury, or damage to personal property.
What this form is
Use this form to submit a claim against the City of Azusa for death, injury to a person, or damage to personal property. The form asks for claimant and incident details, the alleged cause, injury or loss, claimed amounts, supporting bills or estimates, and witness information. It also provides space for an accident diagram and additional comments.
Who needs it
A person submitting a claim to the City of Azusa for death, personal injury, or damage to personal property should complete this form.
How to submit it
Deliver or mail the original completed and executed claim to the City Clerk, City of Azusa, 213 E. Foothill Boulevard, Azusa, CA 91702. The form says claims will not be accepted by fax or email.
About notarization
This document is signed without a notary; the claimant signs and dates a certification under penalty of perjury, and the form does not identify a notarized attachment.
How to submit this form
- 1
Download The Claim Form
Download the City of Azusa Claim Form for damages to persons or personal property.
- 2
Complete The Form
Fill in claimant and incident information, describe the injury or loss, and provide the claimed amounts and other requested details.
- 3
Gather Supporting Materials
Include estimates or receipts. If adding pages, identify the paragraph number and sign each additional sheet.
- 4
Submit The Original Claim
Deliver or mail the completed and executed original to the City Clerk at 213 E. Foothill Boulevard, Azusa, CA 91702. Fax and email are not accepted.
Frequently asked questions
- Do I need a notary for the Azusa claim form?
- No. The form is signed without a notary. The claimant signs and dates a certification under penalty of perjury; the form does not identify a notarized attachment.
- How do I submit the Azusa claim form?
- Deliver or mail the original completed and executed claim to the City Clerk, City of Azusa, 213 E. Foothill Boulevard, Azusa, CA 91702. Faxed and emailed claims are not accepted.
- What information does the claim form ask for?
- It asks for claimant contact information, incident details, the alleged cause, injury or property loss, claimed amounts, supporting bills or estimates, and witness information.
- What should I include with my claim?
- The instructions say to submit estimates or receipts with the claim. If the form's space is insufficient, use additional paper, identify the related paragraph number, and sign each additional sheet.
Need something notarized?
This Claim Form for Damages to Persons or Personal Property doesn’t need a notary — but if you have another Azusa form that does, a commissioned online notary can help.