Get Pierce County Tort Claim Form

This guide provides step-by-step instructions on completing the Pierce County Tort Claim Form online. Follow these detailed directions to ensure that your claim is properly submitted.

Follow the steps to effectively complete the form.

1. Click the ‘Get Form’ button to obtain the form and open it in your editor.
2. Begin with the claimant information section. Enter the claimant's name, including last name, first name, and middle name. Fill in the date of birth in the format mm/dd/yyyy.
3. Provide the current residential address. Make sure to enter the full address accurately.
4. If the mailing address is different from the residential address, include it in the designated field.
5. Fill in the residential address for the six months preceding the date of the incident if it differs from the current address.
6. Enter the claimant's daytime telephone number, including both home and business contact numbers.
7. Provide the claimant’s email address in the space provided.
8. For the incident information section, enter the date of the incident and specify the time, selecting either a.m. or p.m.
9. If the incident occurred over multiple dates, provide the date and time for both the first and last occurrences.
10. Specify the exact location of the incident, including state, county, city (if applicable), and the place where the incident occurred.
11. If applicable, provide the name of the street or highway where the incident took place, and include any relevant milepost information.
12. Identify the state agency or department that is alleged to be responsible for the damage or injury.
13. List the names, addresses, and telephone numbers of all parties involved in or witnessed the incident.
14. Provide the names, addresses, and telephone numbers of any state employees who have knowledge of the incident.
15. Include information about individuals not previously identified and provide a brief description of their knowledge related to the incident.
16. Detail the cause of injury or damages, explaining the extent of property loss or any medical, physical, or mental injuries. If more space is needed, attach additional sheets.
17. Indicate if the incident has been reported to law enforcement or safety personnel, providing details about when and to whom it was reported.
18. List the names, addresses, and contact numbers of any medical providers who have treated the claimant, and attach copies of all medical reports and billings.
19. Attach any supporting documents that substantiate the claims being made.
20. Declare the amount of damages being claimed from the State of Washington. The claimant must sign the form to validate the claim.
21. Indicate the date and place of the signature, providing the residential address, city, and county.
22. Once all sections are complete, save the changes, download the form, or print it for submission.

Complete the Pierce County Tort Claim Form online today for an efficient claims process.