Roy, WA · Pierce County
Standard Tort Claim Form
Claimants use this form to file a tort claim against the named entity and describe the incident, alleged responsibility, injuries, damages, and supporting information.
What this form is
Use this form to file a tort claim against the entity named on the form. It requests claimant contact and address details, incident facts, information about involved people and witnesses, a description of the cause and damages, supporting records, and the amount claimed. The claimant must sign a declaration under penalty of perjury.
Who needs it
A person seeking to file a tort claim against the entity named on the form, or an authorized representative permitted to sign for the claimant, uses this form.
How to submit it
The form says claims cannot be submitted by email or fax and directs the claimant to mail or deliver the original. The destination is not specified; check the city website for current contact details.
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 Standard Tort Claim Form PDF.
- 2
Complete The Form
Type or print in ink, provide the requested claimant and incident information, and state the amount claimed.
- 3
Gather Supporting Documents
Attach documents supporting the claim and copies of medical reports and billings, if applicable.
- 4
Sign And Submit The Original
Sign and date the form, then mail or deliver the original. Do not submit it by email or fax.
Frequently asked questions
- Do I need a notary for the Standard Tort Claim Form?
- No. The form does not require notarization, but the signer must declare under penalty of perjury that the information is true and correct.
- How do I submit the Standard Tort Claim Form?
- Mail or deliver the original form. The document says claims cannot be submitted by email or fax, but does not provide a destination; check the city website for current contact details.
- What information does the form request?
- It asks for claimant and incident details, information about involved people and witnesses, a description of the cause and damages, supporting documents, and the amount claimed.
- What supporting documents should I include?
- The form asks for documents supporting the claim and copies of medical reports and billings. It also allows additional sheets when more space is needed.