Farmington, MI · Oakland County
PA 222 Claim Form
Farmington residents or property owners use this form to report sewage disposal or stormwater system events that caused property damage or personal injury.
What this form is
Use this form to notify the City of Farmington of property damage or personal injury resulting from a sewage disposal or stormwater system event. The form says written notice must be provided within 45 days after the damage or injury was discovered, or should have been discovered through reasonable diligence. It asks about the event, damages, insurance, and supporting records.
Who needs it
Individuals claiming property damage or personal injury from a sewage disposal or stormwater system event can submit this form to the city.
How to submit it
Return the completed form to City of Farmington Department of Public Works, 33720 W. Nine Mile Road, Farmington, MI 48335, or email [email protected].
About notarization
This form does not require a notary; it lists insurance and damage records as supporting items, with no sworn or notarized attachment identified.
How to submit this form
- 1
Download The Claim Form
Download the PA 222 Claim Form PDF.
- 2
Complete The Claim Details
Provide your contact information, affected property address, event details, damage or injury information, and insurance details.
- 3
Gather Supporting Records
For property damage, gather the insurance declaration page, damage photos, receipts, and insurance claim submission and payment or denial records.
- 4
Submit The Form
Return the completed form to Farmington Department of Public Works by mail or email using the contact details on the form.
Frequently asked questions
- What is the PA 222 Claim Form for?
- It gives individuals a way to notify Farmington of property damage or personal injury resulting from a sewage disposal or stormwater system event.
- Do I need a notary for the PA 222 Claim Form?
- No. The form does not require a notary, and it identifies no sworn or notarized attachment.
- How do I submit the PA 222 Claim Form?
- Return it to Farmington Department of Public Works at 33720 W. Nine Mile Road, Farmington, MI 48335, or email [email protected].
- What supporting documents does the form request?
- For property damage, the checklist requests an insurance declaration page showing the deductible, clear damage photos, receipts, and proof of an insurance claim with payment or denial correspondence.
Need something notarized?
This PA 222 Claim Form doesn’t need a notary — but Michigan residents can notarize other documents online with a commissioned online notary.