An Iowa Claimants Statement is a document filed by an individual who has been injured in an accident and is seeking financial damages. The statement is used to provide information to the court about the facts of the accident and the extent of the damage incurred. It must be completed and signed by the claimant before any legal action can be taken. There are two types of Iowa Claimants Statement; the first is an Original Iowa Claimants Statement which is used to initiate a claim in the state of Iowa and the second is a Supplemental Iowa Claimants Statement which is used to provide additional information when an accident has occurred in another state. Both of these documents must be filed with the court in order for a claim to be considered.
Iowa Claimants Statement
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Claimants Statement
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Claimant's Statement. Please read instructions on page 2 before completing this form.Complete the certification ensuring the number is correct and indicating whether you are subject to backup withholding. Please complete this Claimant's Statement and submit ALL required information. Each beneficiary must complete and submit his or her own Claimant's Statement. If the proceeds are payable to the Estate, the executor or administrator of the deceased's Estate must complete the Annuity claimant statement. NOTE: Only one Claimant's Statement and Authorization form is required for each episode of care. A claimant is the person or entity claiming the death benefit under a policy. Each beneficiary must complete a separate Claimant's Statement. Each beneficiary should complete a separate "Claimant's Statement – Death Claim" form.