Black Diamond, WA · King County
Claim for Damages Form
Individuals use this form to submit a tort claim for personal injury or property damage against the city and describe the incident and claimed losses.
What this form is
This form is for submitting a tort claim against the named city or other entity. It asks for claimant contact details, incident and witness information, descriptions of injuries or property damage, and the amount claimed. The instructions request supporting documents, such as medical records, bills, photographs, receipts, or witness statements, and say to submit the original claim form.
Who needs it
A person seeking damages from the city for an incident can use this form to provide the claim details and supporting documents.
How to submit it
Mail or deliver the original claim form to the city or town you are filing against. The form says claims cannot be submitted by email or fax.
About notarization
This document is signed without a notary; the signer declares under penalty of perjury that the information is true and correct.
How to submit this form
- 1
Download the Form
Download the Claim for Damages Form.
- 2
Complete the Form
Type or print clearly in ink, provide the requested claimant and incident information, and sign and date the form.
- 3
Gather Supporting Documents
Attach available documents supporting the claim, such as medical records, bills, photographs, receipts, or witness statements.
- 4
Submit the Original
Mail or deliver the original form to the city or town you are filing against; email and fax submissions are not accepted.
Frequently asked questions
- Do I need a notary for the Claim for Damages Form?
- No. The form does not require a notary; the signer signs and makes a declaration under penalty of perjury that the information is true and correct.
- How do I submit the Claim for Damages Form?
- Mail or deliver the original form to the city or town you are filing against. The form says claims cannot be submitted by email or fax.
- What supporting documents should I include?
- Attach available documents that support the claim, such as medical records or bills, photographs, proof of property ownership, receipts, or witness statements.
- What information does the form ask for?
- It asks for claimant and incident details, witness information, descriptions of injuries or property damage, and the amount of damages claimed.
Need something notarized?
This Claim for Damages Form doesn’t need a notary — but if you have another Black Diamond form that does, a commissioned online notary can help.