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NOTICE OF CLAIM

Steps

  1. 1. Step One
  2. 2. Step Two
  • Step One

    1. 1. General Municipal Law requires that all claims against the City of Plattsburgh be presented WITHIN NINETY (90) DAYS OF THE DATE OF THE DAMAGE, INJURY OR LOSS.
      2. This Notice of Claim must be served on the City Clerk's Office, 41 City Hall Place, Plattsburgh, NY 12901, either by personal service or certified or registered mail. The City of its representative may request additional information regarding this claim.
      3. Call (518) 563-7702 if you have questions regarding this form.
      4. Attach additional pages/items as you deem necessary.

    2. ) ss:
      County of Clinton )

    3. Name:______________________________________________________________________________
      Address:____________________________________________________________________________
      Home Phone:________________________________________________________________________
      Daytime/Buisness Phone:______________________________________________________________
      Legal Representative (if other than Claimant):______________________________________________
      Representative Address/Phone:_________________________________________________________

    4. Date/time:__________________________________________
      Location:___________________________________________
      Brief Description of damage/injury/loss:___________________________________________________________
      ____________________________________________________________________________________________
      ____________________________________________________________________________________________

    5. Agency Name:________________________________________
      To Whom:____________________________________________
      Date/time:____________________________________________

    6. Incident #:_____________________________________________
      Officer:________________________________________________