Holland, MI · Ottawa County
Notice of Sewage Disposal System Claim
This claim form lets people report property damage or physical injury allegedly caused by a sewage disposal system and assert liability against the City of Holland.
What this form is
Use this form to submit a claim to the City of Holland for property damage or physical injury allegedly caused by a sewage disposal system. It asks for claimant contact details, the incident’s date, time, and location, and facts supporting the asserted liability. Claimants must also provide or attach proof of property ownership and damage value; the city may request additional information after submission.
Who needs it
A person seeking to hold the City of Holland liable for property damage or physical injury allegedly caused by a sewage disposal system should complete this form.
How to submit it
Submit the completed claim to the City Clerk, 2nd Floor, City Hall, 270 S. River Avenue, Holland, MI 49423. The form lists phone, fax, and email contacts but does not specify a submission method.
About notarization
This claim is signed without a notary; the claimant signs the form, and no notarized or sworn attachment or related step is identified.
How to submit this form
- 1
Download The Claim Form
Download the Notice of Sewage Disposal System Claim form.
- 2
Complete The Claim
Provide your contact information, incident details, and facts supporting the asserted liability.
- 3
Gather Supporting Proof
Provide or attach proof of ownership and the value of damaged personal property, including purchase or value information and photographic or similar evidence.
- 4
Submit To The City Clerk
Send the completed claim to the City Clerk at the City Hall address listed on the form.
Frequently asked questions
- Do I need a notary for this sewage disposal system claim?
- No. The form provides a claimant signature line and does not identify a notarized or sworn attachment or related step.
- How do I submit the sewage disposal system claim?
- The form names the City Clerk’s office at City Hall, 270 S. River Avenue, Holland, MI 49423. It lists phone, fax, and email contacts but does not specify how to submit the claim.
- What information does the claim form request?
- It requests claimant contact details, the incident date, time, and location, and facts supporting the asserted liability. It also asks for proof of ownership and the value of damaged personal property.
- What happens after I submit the claim?
- The form says the claim will be referred to a City of Holland adjuster for review. You may be contacted for additional information.
Need something notarized?
This Notice of Sewage Disposal System Claim doesn’t need a notary — but Michigan residents can notarize other documents online with a commissioned online notary.