Bothell, WA · King County
Claim for Damages Form
A claimant uses this form to file a tort claim against the City of Bothell for damages arising from an incident.
What this form is
Use this form to file a tort claim against the City of Bothell for damages arising from an incident. It asks for claimant contact details, the claimed amount, incident information, witnesses, insurance details, and supporting documents such as expense records or repair estimates. Automobile claims require additional driver, vehicle, owner, and passenger information. The claimant must sign a declaration under penalty of perjury.
Who needs it
A person claiming damages against the City of Bothell, or an authorized representative signing on that person’s behalf, uses this form.
How to submit it
Serve the completed claim on the City Clerk’s Office or designee at 18415 101st Avenue NE, Bothell, WA 98011, as stated in the instructions.
About notarization
This document does not require a notary; the claimant signs and dates it and declares under penalty of perjury that the information is true and correct.
How to submit this form
- 1
Download The Form
Download the City of Bothell Claim for Damages Form.
- 2
Complete The Form
Type or print clearly in ink, provide the requested claim and incident information, and sign and date the form.
- 3
Gather Supporting Documents
Attach available records relating to expenses, injuries, losses, or repair estimates; use extra sheets if needed.
- 4
Serve The City
Serve the claim on the City Clerk’s Office or designee at the address listed in the instructions.
Frequently asked questions
- Do I need a notary for the Claim for Damages Form?
- No. The form does not require a notary. The claimant signs and dates it and declares under penalty of perjury that the information is true and correct.
- How do I submit the Claim for Damages Form?
- Serve the completed form on the City Clerk’s Office or designee at 18415 101st Avenue NE, Bothell, WA 98011, as directed by the form instructions.
- What supporting documents should I include?
- Attach copies of documentation relating to expenses, injuries, losses, or repair estimates. The instructions also mention evidence such as bills, photographs, proof of ownership, and receipts.
- What information does the form request?
- It asks for claimant contact information, the claimed amount, incident details, witnesses if applicable, insurance information, and additional driver and vehicle details for automobile claims.
Need something notarized?
This Claim for Damages Form doesn’t need a notary — but if you have another Bothell form that does, a commissioned online notary can help.