Notice Of Tort Claim (Page 5 of 8) in pdf

Notice Of Tort Claim Page 5

Please provide documentary evidence showing amounts of income lost.

c. If you claim property damage:

(1) Describe the property damage.

(2) The present location and time when the property may be inspected.

_________________________________________________________________________

(3) Date property acquired.__________________________________________________

(4) Cost of property $_______________________________________________________

(5) Value of property at time of accident. $_____________________________________

(6) Description of damage. __________________________________________________

(7) Has the damage been repaired? _______ If so, by whom, when and cost of repairs.

(8) Attach each estimate of repair costs to this form.

(9) Set forth, in detail, the loss claimed by you for property damage.

d. Set forth, in detail all other items of loss or damages claimed by you and the

method by which you made the calculations.

The amount of the claim.______________________________________________

Notice Of Tort Claim Page 5