Get Mi Dtmb-1104 2023-2026

Filling out the MI DTMB-1104 form online can streamline the process of submitting a claim against the State of Michigan for personal losses under $1,000. This guide will provide you with clear, step-by-step instructions to ensure that your claim is completed accurately and efficiently.

Follow the steps to successfully complete your MI DTMB-1104 form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editing platform.
2. Complete Section 1: Claimant Information. Provide your full name (last, first, middle initial), email address, street address, and telephone number. If you are a state employee, fill in your work location and department.
3. Proceed to Section 2: Claim Information. Indicate the name of the state agency you are filing a claim against, the date and time of the loss, and the location of the loss. Specify the amount you are claiming.
4. Describe your loss, damage, or injury in detail. Clearly articulate how you determined the value of your claim and attach any relevant receipts or documentation.
5. In Section 2: Claim Information, explain why you believe the state agency is responsible for your loss and provide details on why you are not at fault. If applicable, indicate any other claims filed or reimbursements received related to this loss.
6. Complete Section 3: Certification. You will need to sign the form, and it must be notarized. Ensure that you have provided accurate information to the best of your knowledge.
7. If more information is needed, use additional sheets as necessary to ensure clarity and completeness of information. Keep copies of all submitted documents for your records.
8. Finally, save the changes to your form, and download or print it. Submit the original signed and notarized form along with all supporting documents to the appropriate address.

Complete your claim easily by filling out the MI DTMB-1104 form online today.