What information does the Notice of Claim form ask for?

It asks for incident location, date and time, a description of what happened, injury and witness details, report and insurance information, contact details, and the total claim amount.

How do I submit the Notice of Claim?

Mail or hand deliver the completed form to the City of Lake Worth Risk Manager at the address printed on it, or fax it to (817) 237-9684.

Do I need a notary for the Notice of Claim?

No. The form has no notary block; the claimant signs and dates it and acknowledges the statements are true. It specifies no notarized attachment.

What timing does the form state for giving notice?

The form states that written notice must be given within 30 days after the alleged injury or damage, and that no action may be brought until 60 days after notice is filed.

Lake Worth, TX · Tarrant County

No notary required

Notice of Claim

This form lets a person submit a personal injury or property damage claim against the City of Lake Worth and provide supporting incident details.

What this form is

The form is for reporting personal injury or property damage claims against the City of Lake Worth. It asks for incident details, information about injuries, witnesses, reports, insurance, contact details, and the amount claimed, and allows supporting documents to be attached. The form states that written notice must be given within 30 days and that a lawsuit may not be brought until 60 days after notice is filed.

Who needs it

A person injured or whose property was damaged, or someone acting on that person’s behalf, can use this form to notify the city of a claim.

How to submit it

Mail or hand deliver the completed form to the City of Lake Worth Risk Manager, 3805 Adam Grubb, Lake Worth, Texas 76135, or fax it to (817) 237-9684.

About notarization

This form has no notary block and is signed and dated by the claimant; it asks the signer to affirm the statements are true but specifies no notarized attachment.

How to submit this form

1
Download The Form
Download the Notice of Claim PDF for the City of Lake Worth.
2
Complete The Form
Fill in the incident, injury, witness, report, insurance, contact, and claim amount details requested.
3
Gather Supporting Documents
Attach copies of any bills, estimates, photographs, medical reports, or other supporting documents.
4
Sign And Date
Sign and date the form to acknowledge that the statements are true to the best of your knowledge.
5
Submit To The City
Mail or hand deliver the form to the City of Lake Worth Risk Manager, or fax it to the number shown on the form.

Frequently asked questions

What information does the Notice of Claim form ask for?: It asks for incident location, date and time, a description of what happened, injury and witness details, report and insurance information, contact details, and the total claim amount.
How do I submit the Notice of Claim?: Mail or hand deliver the completed form to the City of Lake Worth Risk Manager at the address printed on it, or fax it to (817) 237-9684.
Do I need a notary for the Notice of Claim?: No. The form has no notary block; the claimant signs and dates it and acknowledges the statements are true. It specifies no notarized attachment.
What timing does the form state for giving notice?: The form states that written notice must be given within 30 days after the alleged injury or damage, and that no action may be brought until 60 days after notice is filed.

Need something notarized?

This Notice of Claim doesn’t need a notary — but Texas residents can notarize other documents online with a commissioned online notary.