Grass Valley, CA · Nevada County
Liability Claim for Damages to Person or Property
This form lets a person submit a claim to Grass Valley for damage to a person, personal property, or real property.
What this form is
Use this form to present a claim to Grass Valley for death, personal injury, or damage to personal or real property. The form states that claims for death, personal injury, or personal property damage must be filed within six months of the occurrence, and real property damage claims within one year. It asks for claimant and incident details, claimed damages, witnesses, and related estimates.
Who needs it
A person seeking damages from Grass Valley for death, injury, or damage to personal or real property should complete and submit this claim.
How to submit it
Submit the completed claim to the City Clerk, City of Grass Valley, 125 East Main Street, Grass Valley, CA 95945. The form requests two repair estimates for repair claims.
About notarization
This document is signed without a notary; the claimant signs and dates the claim and certifies its truth under penalty of perjury.
How to submit this form
- 1
Download the Claim Form
Download the Liability Claim for Damages to Person or Property form.
- 2
Complete the Claim
Provide claimant and incident details, explain the claimed damages, and sign and date the certification.
- 3
Gather Attachments
Include two repair estimates when applicable; attach separate details or a signed diagram if needed.
- 4
Submit to the City Clerk
Submit the completed claim to the City Clerk at 125 East Main Street, Grass Valley, CA 95945.
Frequently asked questions
- Do I need a notary for the Liability Claim for Damages?
- No. The claimant signs and dates the form and certifies the claim under penalty of perjury; the form does not require a notary.
- How do I submit the Liability Claim for Damages?
- Submit the completed claim to the City Clerk at 125 East Main Street, Grass Valley, CA 95945. The form requests two estimates for repairs.
- What information does the claim form ask for?
- It asks for claimant contact details, when and where the damage or injury occurred, how it happened, claimed damages, witnesses, and doctor or hospital information for injury claims.
- What attachments may be needed with the claim?
- The form asks for two estimates for repairs and allows separate sheets for additional details. For vehicle accidents, attach a signed diagram if the form's diagram does not fit the situation.
Need something notarized?
This Liability Claim for Damages to Person or Property doesn’t need a notary — but if you have another Grass Valley form that does, a commissioned online notary can help.