Walnut, CA · Los Angeles County
Notice of Claim
This form lets a person submit a claim to the City of Walnut for injury, property damage, or another loss allegedly caused by the city or its employees.
What this form is
Use this form to present a claim to the City of Walnut for injury, personal property damage, or another loss. The form says injury and personal property claims must be presented within six months of the loss, and claims for other losses within one year. It asks for claimant contact details, loss and incident information, damage documentation, and a signed declaration.
Who needs it
A person seeking compensation for injury, property damage, or another loss allegedly caused by the City of Walnut or its employees should complete this form.
How to submit it
Submit it to the City Clerk, City of Walnut, 21201 La Puente Road, Walnut, CA 91789; the form lists no email or online submission option.
About notarization
This document is signed without a notary; it includes a declaration under penalty of perjury, and the claimant signs and dates the claim.
How to submit this form
- 1
Download The Form
Download the City of Walnut Notice of Claim PDF.
- 2
Complete The Claim
Answer each item fully, including claimant details, loss information, damages, and any known city employees or witnesses.
- 3
Gather Supporting Documents
Attach copies of receipts, repair estimates, bills, invoices, or other documentation to prove the loss; use extra pages if needed.
- 4
Sign And Submit
Sign and date the declaration, then submit the claim to the City Clerk at the address printed on the form.
Frequently asked questions
- What is the Notice of Claim used for?
- It lets a claimant report injury, personal property damage, or another loss allegedly caused by the City of Walnut or a city employee.
- Do I need a notary for the Notice of Claim?
- No. The claim is signed without a notary, but it includes a declaration under penalty of perjury that the claimant signs and dates.
- How do I submit the Notice of Claim?
- The form directs claimants to the City Clerk, City of Walnut, at 21201 La Puente Road, Walnut, CA 91789. It does not list email or online submission.
- What information and documents does the form request?
- It requests claimant contact information, details about the loss and incident, damages and estimated losses, and information about employees and witnesses. It also asks for copies of receipts, estimates, bills, invoices, and other proof of loss.
Need something notarized?
This Notice of Claim doesn’t need a notary — but if you have another Walnut form that does, a commissioned online notary can help.