Edgewood, WA · Pierce County
Claim for Damages Form
This form lets a person submit a claim for damages to Edgewood, providing information about the claimant, incident, claimed losses, and supporting records.
What this form is
Use this form to present a claim for damages to Edgewood. It asks for the claimant’s contact details, incident date and location, people with relevant knowledge, the cause and extent of the damages, and the amount claimed. Attach supporting documentation and, for automobile claims, provide vehicle, driver, owner, and passenger information. The claimant or an authorized representative must sign the declaration under penalty of perjury.
Who needs it
A person seeking damages from Edgewood, or an authorized representative permitted by the form, needs to complete and sign this claim.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
No notary is required; the form includes a declaration under penalty of perjury and an optional area for a notary if the claim is notarized.
How to submit this form
- 1
Download The Form
Download the Claim for Damages Form PDF.
- 2
Complete The Claim
Provide claimant and incident information, describe the cause and extent of damages, and state the amount claimed.
- 3
Gather Supporting Records
Attach supporting documentation and, if available, medical provider billings and records. Include the requested vehicle and occupant details for an automobile claim.
- 4
Sign And Submit
Have the claimant or an authorized representative sign and date the declaration, then submit the form to the city department named on it.
Frequently asked questions
- What information does the Claim for Damages Form request?
- It requests claimant and incident details, information about witnesses and others with relevant knowledge, a description of damages, the amount claimed, and supporting records.
- Do I need a notary for the Claim for Damages Form?
- No. The form includes a declaration under penalty of perjury and an optional area for a notary if the claim is notarized.
- How do I submit the Claim for Damages Form?
- The form does not state submission instructions. Submit it to the city department named on the form; check the city website for current contact details.
- What additional information is needed for an automobile claim?
- For automobile claims, the form requests the license plate number, vehicle year, make and model, and names, addresses, and phone numbers for the driver, owner, and passengers.
Need something notarized?
This Claim for Damages Form doesn’t need a notary — but if you have another Edgewood form that does, a commissioned online notary can help.