Millbrae, CA · San Mateo County
Claim Form
Millbrae’s Claim Form lets a person or representative submit a claim to the city for alleged injury, property damage, loss, or another obligation.
What this form is
Use this form to present a claim against the City of Millbrae for an alleged injury, damage, loss, or obligation. It asks for claimant and contact details, incident information, a detailed basis for the claim, a description and value of the loss, and supporting documents. The form’s instructions describe filing time limits and explain when to indicate whether a claim is a limited or unlimited civil case.
Who needs it
A person claiming injury, damage, loss, or another obligation involving the City of Millbrae, or someone submitting a claim on that person’s behalf, should complete this form.
How to submit it
Present the original completed form by mail or personal delivery to the City Clerk, City of Millbrae, 621 Magnolia Avenue, Millbrae, CA 94030. Include supporting documents as applicable.
About notarization
This claim form is signed and dated by the claimant or representative without a notary; the form does not identify any notarized or sworn attachment.
How to submit this form
- 1
Download The Claim Form
Download the Millbrae Claim Form PDF.
- 2
Complete The Form
Provide claimant and contact details, incident information, the basis of the claim, and a description and amount of the alleged loss.
- 3
Gather Supporting Documents
Attach available bills and receipts, and include applicable estimates, photographs, or wage-loss documentation.
- 4
Sign And Date
The claimant or representative must sign and date the form.
- 5
Present The Original
Mail or personally deliver the original completed form to the City Clerk at 621 Magnolia Avenue, Millbrae, CA 94030.
Frequently asked questions
- What is the Millbrae Claim Form used for?
- It is used to submit a claim against the City of Millbrae for alleged injury, damage, loss, or another obligation. It requests incident details and the claimed loss amount.
- Do I need a notary for the Millbrae Claim Form?
- No. The claimant or representative signs and dates this form without a notary. The form does not identify any notarized or sworn attachment.
- How do I submit the Millbrae Claim Form?
- Present the original completed form by mail or personal delivery to the City Clerk at 621 Magnolia Avenue, Millbrae, CA 94030. Attach supporting documents as applicable.
- What supporting documents should I include?
- The instructions say to attach available bills and receipts. For vehicle or other property damage, provide two repair estimates and photographs; wage loss claims should include supporting documentation.
Need something notarized?
This Claim Form doesn’t need a notary — but if you have another Millbrae form that does, a commissioned online notary can help.