Paw Paw, MI · Van Buren County
Sewer Back Up Claim Form
The Sewer Back Up Claim Form lets people report property damage or physical injuries resulting from a sewage disposal event to the Village of Paw Paw.
What this form is
Use this form to provide written notice of a claim for property damage or physical injury caused by a sewage disposal event. The Village says a claimant must file within 45 days after discovering the damage or injury, or when it should have been discovered with reasonable diligence. The form asks for names, addresses, the affected property address, discovery date, and supporting information or documents.
Who needs it
Anyone claiming property damage or physical injury from a sewage disposal event in Paw Paw should complete and submit this form.
How to submit it
Mail or deliver the form to Larry Nielsen, Manager, Village of Paw Paw, 111 Michigan Avenue, PO Box 179, Paw Paw, MI 49079. Attach information and documents supporting the claim.
About notarization
No notary is required; the form identifies no sworn or notarized attachment and asks for claim information and supporting documents.
How to submit this form
- 1
Download The Form
Download the Sewer Back Up Claim Form PDF.
- 2
Complete The Claim Details
Provide your name and address, the affected property address if different, and the date you discovered the damage or injury.
- 3
Gather Supporting Documents
Attach information and documents that support your claim; the form notes that dated pictures may also be helpful.
- 4
Submit The Form
Mail or deliver the form to the Village Manager at the address provided, within the stated 45-day period.
Frequently asked questions
- Do I need a notary for the Sewer Back Up Claim Form?
- No. The form does not require notarization or identify a sworn attachment; include supporting information and documents with your claim.
- How do I submit the Sewer Back Up Claim Form?
- Mail or deliver it to Larry Nielsen, Manager, Village of Paw Paw, 111 Michigan Avenue, PO Box 179, Paw Paw, MI 49079. Include supporting information and documents.
- When must I file a sewer backup claim?
- The document says written notice must be filed within 45 days after the damage or injury was discovered, or when it should have been discovered with reasonable diligence.
Need something notarized?
This Sewer Back Up Claim Form doesn’t need a notary — but Michigan residents can notarize other documents online with a commissioned online notary.