Tiburon, CA · Marin County
Claim Against the Town Form
This form lets a person submit a claim to the Town of Tiburon for an accident, injury, damage, or loss involving the town.
What this form is
Use this form to make a claim against the Town of Tiburon for an accident, injury, damage, or loss. It asks for the claimant’s contact information, the amount claimed, the date and location of the incident, how it occurred, and an itemization of the claim. The claimant certifies the information is true and correct under penalty of perjury, then signs and dates the form.
Who needs it
A person seeking to make a claim against the Town of Tiburon for an accident, injury, damage, or loss can use this form.
How to submit it
Return the completed form to the Tiburon Town Clerk, Town of Tiburon, 1505 Tiburon Boulevard, Tiburon, CA 94920.
About notarization
This document is signed without a notary; it includes a certification under penalty of perjury, and the claimant signs and dates the form.
How to submit this form
- 1
Download the Form
Download the Claim Against the Town Form.
- 2
Complete the Claim Details
Provide claimant and notice information, claim amount, accident or loss details, and an itemization.
- 3
Sign and Date
Certify that the information is true and correct under penalty of perjury, then sign and date the form.
- 4
Return the Form
Return it to the Tiburon Town Clerk at 1505 Tiburon Boulevard, Tiburon, CA 94920.
Frequently asked questions
- What is the Claim Against the Town Form for?
- It lets a claimant report an accident, injury, damage, or loss and state the amount and itemization of a claim against the Town of Tiburon.
- What information does the form ask for?
- It asks for claimant and notice contact information, the amount claimed, accident or loss details, any public employee involved, and an itemization of the claim.
- Do I need a notary for the Claim Against the Town Form?
- No. The form has no notary block; the claimant certifies the information under penalty of perjury and signs and dates it.
- How do I submit the Claim Against the Town Form?
- Return the completed form to the Tiburon Town Clerk at 1505 Tiburon Boulevard, Tiburon, CA 94920.