Stanislaus County, CA · Stanislaus County
Claim Against the County of Stanislaus
Use this claim form to report a loss, damage, or injury and seek payment from the County of Stanislaus.
At a glance
- Issued by
- City of Stanislaus County · Stanislaus County, Stanislaus County, California
- Notarization
- Not required: file this form without a notary.
- Official source
- stancounty.com
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
This form lets a claimant describe an incident and the loss, damage, or injury for which they seek payment from the County of Stanislaus. It asks for incident details, the amount claimed, contact information, and witness or medical provider information. The instructions give presentation time limits based on the type of claim and say available estimates or bills should be attached; auto damage requires two written estimates.
Who needs it
A person seeking payment from the county for a loss, damage, or injury should complete and file this claim.
How to submit it
File the completed, signed, and dated claim with the Board of Supervisors, County of Stanislaus, 1010 10th St., Suite 6500, Modesto, CA 95354. The instructions say claims are filed on the date the office actually receives them.
About notarization
This document is signed and dated without a notary; the instructions mention estimates or bills as attachments, but do not say they must be notarized or sworn.
How to submit this form
- 1
Download the Claim Form
Download the County of Stanislaus claim form.
- 2
Complete the Form
Provide the incident details, claimant information, description of the loss or injury, and amount claimed.
- 3
Gather Supporting Estimates
Attach written estimates or bills if available; auto damage requires two written estimates.
- 4
Sign and Submit
Sign and date the claim, then file it with the Board of Supervisors at the address listed in the instructions.
Frequently asked questions
- Do I need a notary for the claim form?
- No. The claimant or an authorized person signs and dates the form. Any estimates or bills attached are not stated to require notarization or a sworn statement.
- How do I submit the claim?
- File the completed, signed, and dated claim with the Board of Supervisors, County of Stanislaus, at 1010 10th St., Suite 6500, Modesto, CA 95354.
- What should I attach to the claim?
- The instructions say to attach written estimates or bills if available. For auto damage, attach two written estimates.
- What information does the claim form ask for?
- It asks for claimant and notice-recipient details, incident date, time and location, circumstances, loss or injury description, amount claimed, and witness or medical provider information.