Mount Holly, MT · Burlington County
Tort Claim Form
Claimants use this form to notify Mount Holly of a claim against a public entity and provide details about the incident, losses, and supporting documents.
What this form is
The form records who is making the claim, what happened, where and when it occurred, and the injuries, property damage, or other losses claimed. The instructions say claims must be filed within 90 days of the occurrence and list supporting documents to submit, including bills, property damage estimates, and relevant reports. It also asks about insurance coverage and other claims for the same losses.
Who needs it
A person seeking damages from a public entity for an occurrence should complete this form and provide the listed supporting documents.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed and dated without a notary; the signer certifies the statements are true and submits the listed supporting documents.
How to submit this form
- 1
Download The Form
Download the Mount Holly Tort Claim Form PDF.
- 2
Complete The Claim
Enter claimant and incident details, describe the damages, and provide the amount claimed and insurance information requested.
- 3
Gather Supporting Documents
Include the bills, estimates, reports, and wage documentation listed on the form, as applicable.
- 4
Submit To The City
Submit the completed form and documents to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What is the Mount Holly Tort Claim Form for?
- It gives a claimant a way to report an occurrence involving a public entity and describe related injuries, property damage, and other losses.
- What documents should I include with the claim?
- The form lists itemized bills, property damage appraisals and estimates, written reports from expert witnesses and treating physicians, and employer verification of lost wages. Self-employed claimants should include a lost-income calculation.
- Do I need a notary for the Mount Holly Tort Claim Form?
- No. The document does not require notarization; the claimant or person filing on the claimant’s behalf signs and dates it and certifies the statements are true.
- How do I submit the Mount Holly Tort Claim Form?
- Submit it to the city department named on the form; check the city website for current contact details. The instructions suggest certified mail as proof of receipt, but say it is not required.
Need something notarized?
This Tort Claim Form doesn’t need a notary — but if you have another Mount Holly form that does, a commissioned online notary can help.