Mammoth Lakes, CA · Mono County
Claim for Damages Form
Claimants use this form to report injury, property damage, or another loss they believe was caused by the Town or its employees.
What this form is
This form lets a claimant describe an injury, property damage, or other loss they believe was caused by the Town or a Town employee. It requests incident details, damages and supporting documents, information about the alleged cause and witnesses, and a signed declaration. The instructions state when claims must be presented: within six months for injury or personal property damage, or within one year for other losses.
Who needs it
Anyone seeking to make a claim against the Town for injury, property damage, or another loss should complete and present this form.
How to submit it
Address the claim to Jamie Gray, Town Clerk, at P.O. Box 1609, Mammoth Lakes, CA 93546. The form also lists an email address and phone number for the Town Clerk.
About notarization
This document is signed without a notary; the claimant signs a declaration under penalty of perjury and dates the claim.
How to submit this form
- 1
Download The Form
Download the Claim for Damages Form PDF.
- 2
Complete The Claim
Fill in the requested claimant, incident, loss, damages, and witness information as fully as you can.
- 3
Gather Supporting Materials
Attach receipts, estimates, bills, invoices, other documentation, and a picture of damaged property; include a sketch of the incident scene.
- 4
Sign And Date
Sign and date the declaration under penalty of perjury.
- 5
Present The Claim
Address the completed claim to Jamie Gray, Town Clerk, at the mailing address shown on the form.
Frequently asked questions
- What information does the Claim for Damages Form request?
- It asks for claimant contact details, the date and location of loss, incident and damage descriptions, estimated losses, the alleged cause, witnesses, and supporting documentation.
- When must I present a claim for damages?
- The form says claims involving injury or personal property damage must be presented within six months of the loss. Claims for other losses must be presented within one year.
- Do I need a notary for this claim?
- No. The form has no notary block; the claimant signs and dates a declaration under penalty of perjury.
- How do I submit the Claim for Damages Form?
- Address it to Jamie Gray, Town Clerk, at P.O. Box 1609, Mammoth Lakes, CA 93546. The form also lists the Town Clerk’s email and phone number.
Need something notarized?
This Claim for Damages Form doesn’t need a notary — but if you have another Mammoth Lakes form that does, a commissioned online notary can help.