Atascadero, CA · San Luis Obispo County
Liability Claim Form
A liability claim form for people seeking damages from the City of Atascadero after an accident, event, or incident they believe caused injury or loss.
What this form is
Use this form to submit a claim against the City of Atascadero for injury, damage, or loss connected to an accident, event, or incident. It requests claimant contact details, occurrence information, injuries or damage, known employees or witnesses, and claimed amounts. The form asks claimants to attach bills, invoices, or estimates and to sign and date the declaration.
Who needs it
Anyone seeking damages from the City of Atascadero for an injury, damage, or loss should complete and submit this claim form.
How to submit it
Mail or deliver the completed form to the City Clerk, City of Atascadero, 6500 Palma Avenue, Atascadero, CA 93422. Attach bills, invoices, or estimates.
About notarization
This document is signed without a notary; the claimant declares under penalty of perjury that the information is true and correct to the extent known.
How to submit this form
- 1
Download The Form
Download the Liability Claim Form for a claim against the City of Atascadero.
- 2
Complete The Claim
Provide claimant details, occurrence information, injury or damage details, witnesses, and claimed amounts.
- 3
Gather Attachments
Attach bills, invoices, or estimates. Use additional paper if needed and identify information by paragraph number.
- 4
Sign And Submit
Sign and date the declaration, then mail or deliver the completed form to the City Clerk at the listed address.
Frequently asked questions
- Do I need a notary for the Liability Claim Form?
- No. The form does not require notarization. The claimant signs a declaration under penalty of perjury that the information is true and correct to the extent known.
- How do I submit the Liability Claim Form?
- Mail or deliver the completed form to the City Clerk, City of Atascadero, at 6500 Palma Avenue, Atascadero, CA 93422.
- What information does the claim form request?
- It asks for claimant details, the date and location of the occurrence, a description of what happened, injury or damage details, witnesses, and claimed amounts.
- What should I attach to the claim form?
- The form asks claimants to attach bills, invoices, or estimates. If there is not enough space, use additional paper and identify the information by paragraph number.