Winnebago County, IL · Winnebago County
Claim Form
Winnebago County residents and others seeking compensation for injuries or damages submit this form to describe an incident and the amount claimed.
At a glance
- Issued by
- City of Winnebago County · Winnebago County, Winnebago County, Illinois
- Notarization
- Not required: file this form without a notary.
- Official source
- wincoil.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
This form lets a claimant report an incident and request money from Winnebago County for injuries or damages. It asks for contact and incident details, the cause and location, insurance and police report information, witnesses, and why the County is believed responsible. For vehicle damage claims, it requests two itemized estimates on company letterhead or an itemized bill with proof of payment.
Who needs it
Anyone seeking money from Winnebago County for injuries or damages should complete this form and provide the supporting information it requests.
How to submit it
The form lists the Winnebago County Highway Department at 424 N. Springfield Ave., Rockford, IL 61101, and provides phone, fax, and email contact details.
About notarization
This form is signed without a notary; the claimant signs and dates it, and the document does not identify any notarized or sworn attachment.
How to submit this form
- 1
Download the Claim Form
Download the Winnebago County Claim Form PDF.
- 2
Complete the Form
Provide claimant, incident, insurance, damage, witness, and claim amount details, then sign and date the form.
- 3
Gather Supporting Documents
Include a copy of your insurance card and insurance information. For vehicle damage, attach two itemized estimates or an itemized bill with proof of payment.
- 4
Contact the County Department
Use the Highway Department address, fax, or email listed on the form to send your claim and supporting documentation.
Frequently asked questions
- What is the Winnebago County Claim Form for?
- It lets claimants describe an incident, report injuries or damages, explain why they believe the County is responsible, and state the amount they seek.
- What information and documents does the claim form request?
- It requests claimant and incident details, insurance and police report information, witnesses, and a description of injuries or damages. Include an insurance card and insurance information; vehicle damage claims require two estimates or an itemized bill with proof of payment.
- Do I need a notary for the Winnebago County Claim Form?
- No. The form has a signature and date line but no notary block; the claimant signs and dates it. It does not identify any notarized or sworn attachment.
- How do I submit the Winnebago County Claim Form?
- The form lists the Winnebago County Highway Department at 424 N. Springfield Ave., Rockford, IL 61101, with phone, fax, and email contact details.