Modesto, CA · Stanislaus County
Claim for Money or Damages
This form lets a claimant submit a claim for money or damages to the City of Modesto and describe the incident, losses, and reasons the city may be responsible.
What this form is
The Claim for Money or Damages form is used to provide the City of Modesto with information about an injury or property damage claim. It asks for claimant and incident details, the claimed amounts, information about witnesses and medical providers, and insurance details. The form states that the claim must be filed with the City Clerk no later than six months after the incident.
Who needs it
A person seeking money or damages from the City of Modesto for an injury or property damage can use this form to provide claim details.
How to submit it
Send the completed form to the City Clerk, City of Modesto, P.O. Box 642, Modesto, CA 95353. The form lists 209.577.5481 and asks claimants to attach supporting medical bills, invoices, repair estimates, or other supporting documents.
About notarization
This document is signed without a notary; attach supporting medical bills, invoices, or repair estimates as applicable, and the claimant signs the form.
How to submit this form
- 1
Download The Form
Download the Claim for Money or Damages PDF.
- 2
Complete The Form
Enter claimant and incident details, describe the damages or injury, and provide the requested claim and insurance information.
- 3
Gather Supporting Documents
Attach supporting medical bills, invoices, repair estimates, or other supporting documents.
- 4
Sign And Send
Sign the form and send it to the City Clerk, City of Modesto, P.O. Box 642, Modesto, CA 95353.
Frequently asked questions
- What information does the Claim for Money or Damages form request?
- It asks for claimant contact information, incident details, damages or injuries, claimed amounts, witness and medical provider information, and insurance details.
- How do I submit the Claim for Money or Damages form?
- Send it to the City Clerk, City of Modesto, P.O. Box 642, Modesto, CA 95353. The form lists 209.577.5481 and asks for supporting documents such as medical bills or repair estimates.
- Do I need a notary for the Claim for Money or Damages form?
- No. The form has a signature line and does not include a notary block. The claimant signs it; supporting medical bills, invoices, or repair estimates may be attached as applicable.
- When does the form say to file a claim?
- The form states that the claim must be filed with the City Clerk no later than six months after the date of the incident.
Need something notarized?
This Claim for Money or Damages doesn’t need a notary — but if you have another Modesto form that does, a commissioned online notary can help.