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Get NC Form NCIC-T-1 2019-2024

By files a claim against (State Agency or County Board of Education) and that its mailing address is 4. That he has been damaged in the amount of $ by reason of the negligent conduct of the employee/agent named here . (Name(s) of negligent employee/agent) 5. That the injury or accident giving rise to this claim occurred at (Print Name of County and Exact Location Where Accident Occurred) on M. (Month) (Day) (Year) (Time) 6. That the injury or property damage occurred in the following .

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