Citrus Heights, CA · Sacramento County
Claim for Damages to Person or Property
This form lets a person or authorized representative submit a claim to the City of Citrus Heights for alleged injury or damage to person or property.
What this form is
Use this form to present a claim to the City of Citrus Heights for alleged damage or injury. It asks for claimant and representative details, incident date, time and location, a description of what happened, supporting facts, and the amount claimed. The form also requests supporting documentation and a signed, dated certification; read its instructions for filing time limits and completion requirements.
Who needs it
A person claiming injury or property damage, or their attorney or authorized representative, uses this form to file a claim with the City.
How to submit it
Submit the original claim form to the City Clerk, City of Citrus Heights, 6360 Fountain Square Drive, Citrus Heights, CA 95621. The form says claims are not accepted by fax or email.
About notarization
This claim is signed without a notary; it includes a declaration under penalty of perjury, and the claimant or representative signs and dates it.
How to submit this form
- 1
Download The Form
Download the City of Citrus Heights claim form.
- 2
Complete The Applicable Sections
Provide claimant and incident information, describe the alleged damage or injury, and state the amount claimed.
- 3
Gather Supporting Documents
Attach supporting documentation for the amount claimed and separate sheets if needed to provide full details.
- 4
Sign And Date The Form
The claimant or authorized representative must provide an original signature and date.
- 5
Send The Original To The City
Submit the original to the City Clerk at the address provided; the form says fax and email submissions are not accepted.
Frequently asked questions
- What is the Citrus Heights claim form for?
- It lets a person or authorized representative submit a claim to the City for alleged injury or damage to person or property.
- Do I need a notary for the Citrus Heights claim form?
- No. The form requires a signature and date and includes a declaration under penalty of perjury, but it does not require notarization.
- How do I submit the claim form?
- Send the original to the City Clerk at 6360 Fountain Square Drive, Citrus Heights, CA 95621. The form says it will not be accepted by fax or email.
- What information and documents does the form ask for?
- It asks for claimant and incident details, facts supporting the claim, the amount claimed, and copies of supporting documentation for that amount.