1/4/2019 4:59:00 PM
The undersigned hereby presents the following claim against the Town of Truckee in accordance with the provisions of Government Code Section 910.
NAME OF CLAIMANT:
CLAIMANT CONTACT INFORMATION:
MAILING ADDRESS TO WHICH NOTICES FROM THE TOWN ARE TO BE DIRECTED:
DESCRIPTION OF ALLEGED INCIDENT/ACCIDENT, INCLUDING YOUR REASONS FOR BELIEVING THAT THE TOWN IS LIABLE FOR YOUR DAMAGES:
DESCRIPTION OF ALL DAMAGES YOU BELIEVE YOU HAVE INCURRED AS A RESULT OF THE INCIDENT:
NAME(S) OF ANY PUBLIC EMPLOYEE(S) CAUSING THE INJURY, DAMAGE OR LOSS YOU ARE CLAIMING:
DOLLAR AMOUNT OF ALL DAMAGES CLAIMED:
If you have more than 5 photos and/or documents, please send directly to email@example.com.
IF THIS IS A CLAIM FOR INDEMNITY, ON WHAT DATE WERE YOU SERVED WITH THE UNDERLYING LAWSUIT?
I certify (or declare) that the foregoing is true and correct to the best of my knowledge.