San Anselmo, CA · Marin County
Claim for Damages
Claimants use this form to describe an incident, damages or losses, and the amount claimed from the Town of San Anselmo.
What this form is
This form presents a claim for damages against the Town of San Anselmo. It asks for claimant and incident details, injuries or losses, the amount claimed and its calculation, and information about witnesses or a representative. Attach supporting documents and any additional pages needed to explain the claim.
Who needs it
A person seeking to present a claim for damages against the Town of San Anselmo can complete this form.
How to submit it
Submit the original signed form and attachments to the Town Clerk in person or by mail at 525 San Anselmo Ave, San Anselmo, CA 94960.
About notarization
This claim is signed without a notary; the signer certifies under penalty of perjury that the information is true and correct.
How to submit this form
- 1
Download The Form
Download the Claim for Damages PDF.
- 2
Complete The Form
Fill in the claimant, incident, damages, and claim amount details. Sign and date the certification.
- 3
Gather Attachments
Attach supporting documents and any additional pages needed to explain the incident or claim amount.
- 4
Submit To The Town Clerk
Submit the original signed form and attachments to the Town Clerk in person or by mail.
Frequently asked questions
- Do I need a notary for the Claim for Damages?
- No. The form does not require a notary. The signer certifies under penalty of perjury that the information is true and correct.
- How do I submit the Claim for Damages?
- Submit the original signed form with supporting documents to the Town Clerk in person or by mail at 525 San Anselmo Ave, San Anselmo, CA 94960.
- What information does the Claim for Damages request?
- It asks for claimant and incident details, injuries or losses, the total claim amount and its calculation, and available witness or representative information.
- What should I attach to the claim?
- Attach supporting documents and any additional pages needed. The form gives invoices and payment information as examples and asks you to explain if supporting documentation is not attached.
Need something notarized?
This Claim for Damages doesn’t need a notary — but if you have another San Anselmo form that does, a commissioned online notary can help.