Ferndale, WA · Whatcom County
Claim for Damages Form
This form lets a person submit a claim to Ferndale for injury or property damage and provide details about the incident and claimed losses.
What this form is
The Claim for Damages Form collects information about the claimant, the incident, witnesses, known city employees, injuries or property loss, and the amount claimed. It also asks about law enforcement and insurance reports and requests supporting documents, such as medical bills and records when available. Automobile claims require additional vehicle and occupant information. The claimant or an authorized representative must sign the form and declare the information true and correct under penalty of perjury.
Who needs it
A person seeking damages from the city, or an authorized representative signing on that person’s behalf, completes and submits this form.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed without a notary; the claimant or authorized signer signs and dates the declaration under penalty of perjury.
How to submit this form
- 1
Download the Form
Download the Claim for Damages Form PDF.
- 2
Complete the Form
Provide claimant and incident information, describe the damages, and state the amount claimed.
- 3
Gather Supporting Documents
Attach available medical bills and records, other documentation supporting the claim, and additional sheets if needed.
- 4
Sign and Submit
The claimant or an authorized signer signs and dates the declaration, then submits the form to the city department named on it.
Frequently asked questions
- What information does the Claim for Damages Form request?
- It asks for claimant and incident details, witnesses, injury or property loss information, the amount claimed, and supporting documentation. Automobile claims have additional questions.
- Who may sign the Claim for Damages Form?
- The claimant may sign, as may a person holding the claimant’s written power of attorney, an attorney admitted to practice in Washington State acting for the claimant, or an approved guardian or guardian ad litem.
- Do I need a notary for the Claim for Damages Form?
- No. The claimant or authorized signer signs and dates the declaration under penalty of perjury; notarization is not required.
- How do I submit the Claim for Damages Form?
- Submit it to the city department named on the form; check the city website for current contact details.