Wheatland, CA · Yuba County
Claim Form
This form lets a claimant submit a claim against the City of Wheatland and describe the incident, alleged harm, and damages.
What this form is
Use this form to submit a claim against the City of Wheatland for an incident or event. It asks for the claimant’s contact information, incident details, alleged causes, injuries or property loss, damages, witnesses, and other relevant information. The form says a claim must be filed within six months of the incident, with a stated one-year exception for certain claims.
Who needs it
A person submitting a claim against the City of Wheatland for injury, property damage, or another loss should complete this form.
How to submit it
Mail or deliver the completed original to the City of Wheatland, 111 C Street, Wheatland, CA 95692. The form states a six-month filing period and notes a one-year exception for certain claims.
About notarization
This document does not require a notary; the claimant signs and dates it and certifies the statements are true or correct under penalty of perjury.
How to submit this form
- 1
Download The Claim Form
Download the City of Wheatland Claim Form PDF.
- 2
Complete The Form
Enter the claimant’s information and describe the incident, alleged harm, damages, witnesses, and other relevant details.
- 3
Gather Additional Pages
Attach additional pages as necessary and identify the information by paragraph number.
- 4
Sign And Date The Form
Sign and date the claim, and complete the certification included on the form.
- 5
Submit The Original
Mail or deliver the completed original to the City of Wheatland at 111 C Street, Wheatland, CA 95692.
Frequently asked questions
- What is the Wheatland Claim Form for?
- It is used to submit a claim against the City of Wheatland and provide information about the incident, alleged harm, and claimed damages.
- Who should complete this claim form?
- A claimant submitting a claim against the City of Wheatland should provide the requested contact, incident, loss, damages, and related information.
- Do I need a notary for this claim form?
- No. The form does not require a notary, but the claimant signs and dates it and certifies the statements are true or correct under penalty of perjury.
- How do I submit the claim form?
- Mail or deliver the completed original to the City of Wheatland, 111 C Street, Wheatland, CA 95692. The form states a six-month filing period, with a one-year exception for certain claims.