Holland, MI · Ottawa County
Notice of Claim for Injuries
This notice of claim form records an injury or property-damage claim and is filed by a claimant or representative with the City of Holland City Clerk’s Office.
- licensed online notary
- ~15 min average
- Notarized PDF emailed
What you’ll need
- Government-issued photo ID
- Webcam-enabled device (laptop or phone)
- This form, ready to upload as a PDF
What this form is
The form records details about an incident, including its location, date, manner of occurrence, alleged negligence, witnesses, and claimed damages. Holland’s form cites Section 16.1 of the City Charter, which describes notice and claim requirements, including a 60-day notice period after an injury. The claimant or representative completes the information, signs before a notary, and returns the form to the City Clerk’s Office; photos, receipts, and other materials may be attached.
Who needs it
A person injured, or whose property was damaged, in circumstances described on the form may use it to submit a claim to the City Clerk’s Office.
Why it needs a notary
The form includes a Michigan notarial certificate with a commission-expiration field; the claimant or representative must sign the affirmation in the notary’s presence.
How to get this notarized
- 1
Download the Form
Get the Notice of Claim form from the City of Holland’s document page.
- 2
Complete the Claim Details
Fill in claimant and incident information, describe damages, and add any supporting materials you wish to include.
- 3
Book an Online Notary
Arrange a remote appointment with a commissioned online notary.
- 4
Sign on Video
Sign the claimant or representative affirmation during the online notarization appointment.
- 5
Submit to the City
Return the completed form to the City of Holland City Clerk’s Office.
Preview the form
The blank PDF straight from Holland. Look it over, then upload your filled copy to start the notary session.
You’ll need ID and a webcam.
A licensed online notary will join you on video, verify your government-issued ID, witness your signature, and apply their seal. You’ll receive the notarized PDF by email when the session ends.
Frequently asked questions
- How do I submit a completed Notice of Claim?
- Return the completed form to the City of Holland City Clerk’s Office at 270 S River Avenue, Holland, MI 49423. The form also lists the Clerk’s phone, fax, and email.
- Do I need to sign the form in front of a notary?
- Yes. The form says the claimant or representative must sign the affirmation in the presence of a notary, and it includes a notarial certificate and commission-expiration field.
- Can I sign this form with a commissioned online notary?
- Michigan authorizes remote electronic notarization by its notaries under the Michigan Law on Notarial Acts, MCL 55.261 et seq. Ask the City Clerk’s Office whether it accepts a remotely notarized form.
- What information and attachments does the form ask for?
- It requests claimant details, incident location and circumstances, damages, alleged negligence, and known witnesses. The form says photos, receipts, and other materials may be attached.
- How soon does the form say notice must be served?
- The form quotes Section 16.1 of the Holland City Charter, which describes serving notice within 60 days after an injury. Confirm with the city, village or township if unsure.