Green, OH · Summit County
Liability Loss Claim Form
Green residents or businesses can use this form to describe an incident and request relief for a loss.
What this form is
Use this form to provide details about an incident for which you are claiming relief from the City of Green. It asks for your contact information, the date and circumstances of the loss, witness details, and whether you have supporting documentation. Attach any supporting records and repair or replacement estimates, then sign and date the form.
Who needs it
A person claiming relief for a loss should complete this form and provide details about the incident.
How to submit it
Contact the Law Department using the listed address, P.O. Box 278, Green, Ohio 44232-0278, or email [email protected].
About notarization
This form is signed and dated without a notary; supporting documents and repair or replacement estimates are attached, not sworn.
How to submit this form
- 1
Download the Form
Download the Liability Loss Claim Form PDF.
- 2
Complete the Form
Enter your contact information, date of loss, incident details, and witness information.
- 3
Gather Attachments
Attach any supporting documentation and estimates for repair or replacement.
- 4
Sign and Contact the Law Department
Sign and date the form, then contact the Law Department using the address or email listed on it.
Frequently asked questions
- What information does the Liability Loss Claim Form request?
- It requests contact details, the date and circumstances of the loss, witness information, and whether supporting documentation is available.
- What should I attach to the claim form?
- Attach supporting documentation, such as photographs, receipts, or videotape, if available. The form also asks for estimates for repair or replacement.
- Do I need a notary for the Liability Loss Claim Form?
- No. The form has a signature and date line but no notary block; supporting documents and repair or replacement estimates are attached, not sworn.
- How do I submit the Liability Loss Claim Form?
- The form lists the Law Department at P.O. Box 278, Green, Ohio 44232-0278, and [email protected] for contact.