Standard Tort Claim Form printable pdf download

Standard Tort Claim Form

Standard Tort Claim Form Packet

Please

before completing and presenting your

carefully read all of the information in this packet

Standard Tort Claim.

A New Law that Impacts Presenting a Standard Tort Claim Form

Engrossed Substitute House Bill 1553, effective July 26, 2009, requires citizens to present the Standard

Tort Claim form to the agent or other person designated to accept delivery at the agent's office. The law

also requires the District to provide a Standard Tort Claim form with instructions. In compliance with these

requirements and for the convenience of citizens, Public Hospital District No. 1 of Mason County

developed a Standard Tort Claim Form Packet.

Documents Contained in the Standard Tort Claim Form Packet

1. Instructions for completing the Standard Tort Claim Form

2. Standard Tort Claim Form (SF 210)

3. Vehicle Collision Form only for tort claims involving vehicle accidents/collisions

Legal Requirements for Presenting Standard Tort Claim Forms

In order to verify the claim and additional supporting information, the law requires that the Standard

Tort Claim form be signed by:

•

Claimant; or

•

Person holding a written power of attorney from the Claimant; or

•

Attorney in fact for the Claimant; or

•

Attorney admitted to practice in Washington State on the Claimant's behalf; or

•

A court-approved guardian or guardian ad litem on behalf of the Claimant

Present in Person or Mail the Standard Tort Claim Form and Supporting Documents to:

Eric Moll

Superintendent of the District

901 Mt. View Drive

Bldg 1

Shelton, WA 98584

Business Hours: Monday-Friday, 8:00 a.m. to 5:00 p.m.

Closed on weekends and official state holidays.

Standard Tort Claim Form