Get Claims For Damages Form - Kitsap Public Health District

Filing a claim for damages with the Kitsap Public Health District can be a straightforward process if you follow the proper steps. This guide will provide you with detailed instructions on how to effectively complete the CLAIMS FOR DAMAGES FORM online.

Follow the steps to complete the form accurately and efficiently.

1. Press the ‘Get Form’ button to access the claim form and open it for editing.
2. Complete the claimant information section. Include your full name (last, first, middle), date of birth, and both current and mailing addresses. If you’ve lived at a different address for the last six months, include that as well. Don’t forget to enter your daytime phone numbers and email address.
3. Fill in the incident information. Record the exact date of the incident, checking whether it occurred in the a.m. or p.m., and provide the time.
4. If the incident spanned multiple days, detail the first and last occurrences with their respective times.
5. Provide the location of the incident. Include the state, county, city (if applicable), and specific street or highway where the event took place.
6. Identify the district or agency you believe is responsible for the damages or injuries.
7. List the names, addresses, and phone numbers of all individuals involved or witnessing the incident.
8. Include the names, addresses, and numbers of any Kitsap Public Health District employees who were aware of the incident.
9. Document any additional individuals with knowledge regarding the incident or the damages sustained, along with brief descriptions of their knowledge.
10. Describe the cause of the injury or damage clearly, outlining the extent of property loss or any medical, physical, or mental injuries. Attach further information as necessary.
11. Indicate if the incident was reported to law enforcement or security personnel, and provide details about when and to whom.
12. If applicable, provide the names, addresses, and phone numbers of your treating medical providers and attach any medical reports or billing documentation.
13. Attach all supporting documents related to your claim allegations.
14. State the amount of damages you are claiming.
15. If filing an automobile claim, include the vehicle’s license plate number, driver's license number, make, model, year and the addresses of the driver and owner.
16. Finish the form by signing it, ensuring it is notarized, as this is necessary for submission.

Complete your claims for damages form online today to ensure your claim is properly submitted!