Raymond, WA · Pacific County
Tort Claim Form
Claimants use this form to submit a tort claim against the named entity, describe the incident and damages, and provide supporting documents.
What this form is
Use this form to submit a tort claim against the entity named on it. It asks for claimant and attorney information, incident details, injuries or property damage, witnesses, and the amount claimed. The form says to attach documents supporting the allegations and to mail or deliver the original; it cannot be submitted by email or fax.
Who needs it
A person submitting a tort claim against the entity named on the form, or an authorized representative signing on the claimant’s behalf, uses it.
How to submit it
Mail or deliver the original claim form with documents supporting the claim’s allegations; the form says it cannot be submitted by email or fax. Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This form 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 Tort Claim Form PDF.
- 2
Complete the Form
Fill in claimant, incident, witness, damage, and claim amount information.
- 3
Gather Supporting Documents
Attach documents that support the claim’s allegations.
- 4
Sign and Submit
Sign and date the form, then mail or deliver the original. Do not submit it by email or fax.
Frequently asked questions
- What information does the Tort Claim Form ask for?
- It asks for claimant and attorney information, incident details, injuries or property damage, witnesses, and the amount claimed. Supporting documents should be attached.
- How do I submit the Tort Claim Form?
- Mail or deliver the original form with documents supporting the claim. The form says claims cannot be submitted by email or fax; check the city website for current contact details.
- Do I need a notary for the Tort Claim Form?
- No. The form is signed without a notary; the signer declares under penalty of perjury that the information is true and correct.