Fairfax, CA · Marin County
Claim Against the Town of Fairfax
This form lets a claimant submit a claim to the Town of Fairfax for an injury, damage, or loss allegedly caused by the Town or its employee.
What this form is
Use this form to present a claim against the Town of Fairfax for an injury, damage, or loss. It asks for the claimant’s contact details, incident information, the Town’s or employee’s alleged role, the losses claimed, and the amount sought with an itemized calculation. The form says to use its back or a separate sheet when more detail is needed.
Who needs it
A person seeking compensation from the Town of Fairfax for an injury, damage, or loss allegedly caused by the Town or its employee can use this form.
How to submit it
Submit the completed form to the Town Clerk, Town of Fairfax, 142 Bolinas Rd., Fairfax, CA 94930. The form also lists the Town Clerk’s phone number as (415) 453-1584.
About notarization
This claim is signed and dated without a notary; the form mentions no notarized or sworn attachment or related step.
How to submit this form
- 1
Download the Claim Form
Download the Claim Against the Town of Fairfax form.
- 2
Complete the Claim Details
Enter claimant and incident information, describe the alleged cause and losses, and itemize the amount sought.
- 3
Add More Detail if Needed
Use the back of the form or a separate sheet if more detail is needed to answer the questions.
- 4
Sign and Date the Form
Provide the date signed and claimant signature; if a representative signs, provide the requested representative details.
- 5
Submit to the Town Clerk
Submit the completed form to the Town Clerk at 142 Bolinas Rd., Fairfax, CA 94930.
Frequently asked questions
- What is the Claim Against the Town of Fairfax form for?
- It lets a claimant describe an injury, damage, or loss allegedly caused by the Town or an employee and state the amount sought.
- What information does the claim form ask for?
- It asks for claimant contact details, incident dates and location, what the Town or employee allegedly did, the injuries or losses, and an itemized amount sought.
- How do I submit the Claim Against the Town of Fairfax?
- Send the completed form to the Town Clerk, Town of Fairfax, 142 Bolinas Rd., Fairfax, CA 94930. The form lists (415) 453-1584 as the Town Clerk’s phone number.
- Do I need a notary for the Claim Against the Town of Fairfax?
- No. Sign and date the claim; the form does not mention a notarized or sworn attachment or related step.