San Juan Capistrano, CA · Orange County
Claim Form
The Claim Form allows a person seeking damages for injury or loss to submit details of the claim to the City of San Juan Capistrano.
What this form is
Use this form to present a claim to the City of San Juan Capistrano for damage or injury. It asks when and where the incident occurred, how it happened, what city employee action or omission caused it, the damages claimed, and information about witnesses, doctors, and hospitals. The form also requests a breakdown of damages and the claimant’s signature.
Who needs it
A person claiming injury or damage caused by an act or omission of City officers or employees should complete this form.
How to submit it
Submit the completed form to the City Clerk, City of San Juan Capistrano, 32400 Paseo Adelanto, San Juan Capistrano, CA 92675. The form lists (949) 493-1171 as the City Clerk’s phone number.
About notarization
This document is signed and dated without a notary; the form does not identify a notarized or sworn attachment or related step.
How to submit this form
- 1
Download The Form
Download the Claim Form to prepare your submission to the City of San Juan Capistrano.
- 2
Complete The Form
Provide claimant contact details, incident information, the amount claimed, a damages breakdown, and requested witness and medical provider contacts.
- 3
Gather Supplemental Details
Add supplemental sheets if required to provide full details of how the damage or injury occurred.
- 4
Sign And Submit
Date and sign the form, then submit it to the City Clerk at the address printed on the form.
Frequently asked questions
- Do I need a notary for the Claim Form?
- No. The form provides a signature and date line and does not identify a notarized or sworn attachment or related step.
- How do I submit the Claim Form?
- Send it to the City Clerk, City of San Juan Capistrano, 32400 Paseo Adelanto, San Juan Capistrano, CA 92675.
- What information does the Claim Form ask for?
- It asks for incident details, the claimed injury or damage, a total amount and damages breakdown, and contact information for witnesses, doctors, and hospitals.
Need something notarized?
This Claim Form doesn’t need a notary — but if you have another San Juan Capistrano form that does, a commissioned online notary can help.