Mukilteo, WA · Snohomish County
Claim for Damages Form
This form lets a person submit a claim for damages to the City of Mukilteo and describe the incident, losses, and supporting information.
What this form is
Use this form to submit a claim for damages to the City of Mukilteo. It asks for claimant contact information, incident details, witnesses and others with relevant knowledge, the cause and extent of damages, and the amount claimed. Claimants can attach supporting documents and medical records; automobile claims require additional vehicle and driver information. The form also includes a declaration and signature lines.
Who needs it
A person seeking damages from the City of Mukilteo should complete and sign this form or have an authorized representative sign it.
How to submit it
Mail or deliver the completed claim form to City of Mukilteo, 11930 Cyrus Way, Mukilteo, WA 98275. The form lists hours as Monday–Thursday, 7:30 AM–5:00 PM, and Friday, 7:30 AM–4:30 PM.
About notarization
A notary is not required; sign and date the form’s declaration under penalty of perjury, and its optional notary section is only for a claim that is notarized.
How to submit this form
- 1
Download The Form
Download the City of Mukilteo Claim for Damages Form PDF.
- 2
Complete The Form
Fill in claimant and incident information, describe the damages, enter the amount claimed, and sign and date the declaration.
- 3
Gather Supporting Documents
Attach supporting documentation and, if available, medical provider billings and records. Include automobile details for an automobile claim.
- 4
Submit To The City
Mail or deliver the completed form to City of Mukilteo, 11930 Cyrus Way, Mukilteo, WA 98275.
Frequently asked questions
- Do I need a notary for this claim form?
- No. Sign and date the declaration under penalty of perjury. The form includes an optional notary section, but notarization is not required.
- How do I submit the claim form?
- Mail or deliver it to City of Mukilteo, 11930 Cyrus Way, Mukilteo, WA 98275. The form also lists the city's hours.
- What information does the claim form ask for?
- It requests claimant and incident details, information about witnesses and others with knowledge, a description of the damages, and the amount claimed.
- What extra information is needed for automobile claims?
- For automobile claims, the form asks for the license plate, year, make and model, plus names and contact information for the driver, owner, and passengers.