Rialto, CA · San Bernardino County
Liability Claim for Damages to Person or Property
This claim form lets a person or their agent report injury, death, or property damage and request compensation from the City of Rialto.
What this form is
Use this form to present a claim to Rialto for death, personal injury, personal property damage, or real property damage. It asks when and where the incident occurred, how it happened, the amount claimed, and information about witnesses and medical visits. The form states different filing periods for injury or personal property claims and real property claims; it also requests two estimates and allows separate sheets for details.
Who needs it
A person or agent seeking compensation from Rialto for death, injury, or property damage should complete and sign this claim form.
How to submit it
Return the completed claim to the Rialto City Clerk’s Office at 150 S. Palm Ave., Rialto, CA 92376. The form requests two estimates and says to attach separate sheets if needed.
About notarization
This document is signed without a notary; the claimant signs and dates a declaration under penalty of perjury, and any added diagram must also be signed.
How to submit this form
- 1
Download The Claim Form
Download the Rialto Liability Claim for Damages to Person or Property PDF.
- 2
Complete The Claim
Enter claimant and incident details, describe the claimed damages, and provide the total amount and its calculation.
- 3
Gather Supporting Details
Attach two estimates and any separate sheets needed. Include a signed diagram if the form’s diagram does not fit the situation.
- 4
Sign And Submit
Sign and date the declaration, then return the claim to the Rialto City Clerk’s Office at 150 S. Palm Ave., Rialto, CA 92376.
Frequently asked questions
- What is the Rialto liability claim form for?
- It lets a claimant report death, injury, or property damage and request compensation from the City of Rialto, providing incident details and the amount claimed.
- Who should complete this claim form?
- A person making a claim for injury or property damage, or an agent acting for the claimant, can complete and sign the form.
- Do I need a notary for the Rialto liability claim form?
- No. The claimant signs and dates a declaration under penalty of perjury without a notary; any added diagram must also be signed by the claimant.
- How do I submit the Rialto liability claim form?
- Return it to the Rialto City Clerk’s Office, 150 S. Palm Ave., Rialto, CA 92376. Attach two estimates and any separate sheets or signed diagram needed.
Need something notarized?
This Liability Claim for Damages to Person or Property doesn’t need a notary — but if you have another Rialto form that does, a commissioned online notary can help.