Yountville, CA · Napa County
Liability Claim for Damages to Person or Property
This form lets a person submit a claim to the Town of Yountville for injury or damage to personal or real property.
What this form is
Use this form to tell the Town of Yountville about an injury or property damage and the amount claimed. It asks when and where the incident occurred, what caused the loss, details about expenses and estimated future damages, and information about witnesses or medical care. The form also requests two estimates and allows additional sheets or a signed diagram when needed.
Who needs it
A person seeking compensation from the Town of Yountville for an injury or damage to personal or real property can use this claim form.
How to submit it
Return the completed claim to the Town Clerk, Town of Yountville, 6550 Yount Street, Yountville, CA 94599. Attach two estimates and any additional sheets or diagram needed to explain the claim.
About notarization
This document is signed without a notary; the claimant signs and dates a declaration under penalty of perjury, and no notarized attachment is specified.
How to submit this form
- 1
Download The Claim Form
Download the Town of Yountville Liability Claim for Damages to Person or Property PDF.
- 2
Complete The Claim Details
Provide claimant information, incident details, the amount claimed and its calculation, and witness or medical information when applicable.
- 3
Gather Supporting Materials
Attach two estimates and any additional sheets needed. For a vehicle accident, include a signed diagram if the form's diagram does not fit.
- 4
Sign And Return The Claim
Sign and date the declaration, then return the claim to the Town Clerk at 6550 Yount Street, Yountville, CA 94599.
Frequently asked questions
- What is the Yountville liability claim form for?
- It is used to submit a claim to the Town of Yountville for injury or damage to a person or property, with details about the incident and claimed losses.
- Do I need a notary for the Yountville liability claim form?
- No. The form has no notary block; the claimant signs and dates a declaration under penalty of perjury. It does not specify a notarized attachment.
- How do I submit the Yountville liability claim?
- Return it to the Town Clerk at 6550 Yount Street, Yountville, CA 94599. The form asks for two estimates and allows additional sheets or a signed diagram.
- What information does the claim form request?
- It asks for claimant contact information, incident details, the claimed amount and its calculation, witnesses, and medical care information if someone was injured.