Maywood, CA · Los Angeles County
Claim For Damages Form
Maywood residents and others claiming injury or property damage submit this form to the City Clerk to describe the incident and requested damages.
What this form is
Use this form to report a claim for injury or damage to personal or real property and explain what happened, where it occurred, and what act or omission caused it. The form states that claims for death, personal injury, or personal property damage must be filed within six months, and real property damage claims within one year. It asks for claimant and incident details, damages, expenses, insurance, witnesses, and supporting estimates.
Who needs it
Anyone filing a claim with Maywood for death, injury to a person, or damage to personal or real property needs to complete this form.
How to submit it
File the original, not a photocopy, with the City Clerk at 4319 E. Slauson Ave., Maywood, CA 90270. Attach two repair estimates for property damage.
About notarization
This claim is signed and dated without a notary; if the diagram does not apply, the claimant must attach a separate drawing and sign it.
How to submit this form
- 1
Download The Form
Download the Maywood Claim for Damages Form.
- 2
Complete Every Question
Answer each question; write N/A if a question does not apply. Attach additional details if needed.
- 3
Gather Supporting Materials
For property damage, attach two repair estimates. If the diagram does not apply, attach a separate drawing signed by the claimant.
- 4
Sign And File The Original
Sign and date the form, then file the original with the City Clerk at 4319 E. Slauson Ave., Maywood, CA 90270.
Frequently asked questions
- Do I need a notary for the Claim for Damages Form?
- No. The form requires the claimant or representative to sign and date it, not to have it notarized. A separate drawing attached when the diagram does not apply must also be signed.
- How do I submit the Claim for Damages Form?
- File the original form with the City Clerk at 4319 E. Slauson Ave., Maywood, CA 90270. The form says photocopies are not accepted; include two repair estimates for property damage.
- What information does the claim form ask for?
- It asks for claimant contact details, incident facts and location, the alleged cause, claimed damages and amounts, expenses, insurance information, and witness or medical provider contacts.
- What attachments are required for property damage?
- The form says to attach two repair estimates when submitting a property damage claim. If the incident diagram does not apply, attach a separate drawing signed by the claimant.
Need something notarized?
This Claim For Damages Form doesn’t need a notary — but if you have another Maywood form that does, a commissioned online notary can help.