Get El Dorado County Tort Claims Form
IONS FOR FILING A CLAIM ON THE BACK OF THIS FORM. YOU MAY MAKE A COPY OF THE COMPLETED FORM FOR YOUR RECORDS. YOU MUST COMPLETE EACH SECTION OF THIS FORM OR YOUR CLAIM MAY BE RETURNED TO YOU AS INSUFFICIENT.* 2. SPECIFY THE TOTAL DOLLAR AMOUNT OF CLAIM AS A DIRECT RESULT OF THE INCIDENT: $ 1.NAME AND MAILING ADDRESS OF CLAIMANTS 3. WHERE DID THE DAMAGE OR INJURY OCCUR? (PLEASE INCLUDE STREET ADDRESS OR INTERSECTION): NAME MAILING ADDRESS CITY STATE SOCIAL SECURITY NUMBER ZIP DATE OF BIR.
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