Claim for Damages Against the Town of Truckee

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Please correct the field(s) marked in red below:

The undersigned hereby presents the following claim against the Town of Truckee in accordance with the provisions of Government Code Section 910.

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NAME OF CLAIMANT:

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CLAIMANT CONTACT INFORMATION:

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CLAIMANT CONTACT INFORMATION:
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MAILING ADDRESS TO WHICH NOTICES FROM THE TOWN ARE TO BE DIRECTED:

MAILING ADDRESS TO WHICH NOTICES FROM THE TOWN ARE TO BE DIRECTED:
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INCIDENT INFORMATION:

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INCIDENT INFORMATION:
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DESCRIPTION OF ALLEGED INCIDENT/ACCIDENT, INCLUDING YOUR REASONS FOR BELIEVING THAT THE TOWN IS LIABLE FOR YOUR DAMAGES:

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DESCRIPTION OF ALLEGED INCIDENT/ACCIDENT, INCLUDING YOUR REASONS FOR BELIEVING THAT THE TOWN IS LIABLE FOR YOUR DAMAGES:
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DESCRIPTION OF ALL DAMAGES YOU BELIEVE YOU HAVE INCURRED AS A RESULT OF THE INCIDENT:

DESCRIPTION OF ALL DAMAGES YOU BELIEVE YOU HAVE INCURRED AS A RESULT OF THE INCIDENT:
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NAME(S) OF ANY PUBLIC EMPLOYEE(S) CAUSING THE INJURY, DAMAGE OR LOSS YOU ARE CLAIMING:

NAME(S) OF ANY PUBLIC EMPLOYEE(S) CAUSING THE INJURY, DAMAGE OR LOSS YOU ARE CLAIMING:
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DOLLAR AMOUNT OF ALL DAMAGES CLAIMED:

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DOLLAR AMOUNT OF ALL DAMAGES CLAIMED:

If you have more than 5 photos and/or documents, please send directly to claims@townoftruckee.com.

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IF THIS IS A CLAIM FOR INDEMNITY, ON WHAT DATE WERE YOU SERVED WITH THE UNDERLYING LAWSUIT?

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I certify (or declare) that the foregoing is true and correct to the best of my knowledge.

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I certify (or declare) that the foregoing is true and correct to the best of my knowledge.
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