Get Claim Form - Butte County

This guide provides clear and supportive instructions on how to fill out the Claim Form for damages to person or property in Butte County. It aims to assist users of all backgrounds in navigating the online form efficiently and accurately.

Follow the steps to fill out the Claim Form successfully.

1. Press the ‘Get Form’ button to access the Claim Form - Butte County and open it in your preferred editing tool.
2. Begin by entering your personal information. Fill in the name of the claimant, date of birth, home address, city, state, zip code, home telephone number, and mailing address if different from your home address.
3. Provide the occupation of the claimant, along with their business address, city, state, zip code, and business telephone number.
4. Indicate the address and telephone number where you would like to receive notices or communications regarding this claim.
5. Document when the damage or injury occurred by specifying the date and time.
6. If applicable, provide the date when the claimant was served with the complaint if the claim is for equitable indemnity.
7. Enter the claimant's social security number and list the names of any county employees involved in the incident.
8. Describe the location of the damage or injury in detail, including street names, address, and measurements from landmarks, and refer to the diagram on the reverse side.
9. Detail how the damage or injury occurred, your reasons for claiming the county’s responsibility, and provide a thorough description of each injury or damage.
10. Calculate the total amount of damages claimed by listing damages incurred to date, such as property damage, medical expenses, and loss of earnings.
11. Include estimated prospective damages, if known, which may consist of future medical expenses and loss of earnings.
12. Indicate whether law enforcement investigated the damage or injury, and provide details on any ambulance or paramedic services involved.
13. List any witnesses who have information regarding the damage or injury, including their names, addresses, and phone numbers.
14. Document any medical attention received, including names of hospitals or doctors along with their addresses and dates of treatment.
15. Complete the diagram section accurately to indicate the location of the incident, marking specific points like the county vehicle, if involved.
16. Finally, ensure that the claim is signed on the reverse side by the claimant or by a person filing on their behalf, including their relationship to the claimant.
17. After reviewing all entered information for accuracy, save your changes, then download, print, or share the completed form as necessary.

Complete the Claim Form online to ensure your claim is filed accurately and on time.