HE INJURY OR DAMAGE OCCURRED. DO NOT WRITE IN THIS SPACE Claim No.: Print Form Supplement No.: If a SUPPLEMENT to a previously filed claim, provide original Claim Number: FILE THIS FORM AND ALL DOCUMENTS BY MAILING TO: State Board of Adjustment 600 Dexter Avenue, Suite E-302 Montgomery, AL 36130-1435 The burden of proving that payment is due rests with the claimant. OR DELIVER TO: State Board of Adjustment State Capitol Building, Suite E-310 Give complete information and attach all documen.
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