Department of Law

Claim Form

If you've been involved in an accident and think you have a claim against the Metropolitan Government, please fill in the following information and someone in our Claims Division will contact you as soon as possible.

Accident Date:
Accident Time:
Accident Location:
Claimant's Name:
Parents' Names:
(Minors Only)
E-Mail Address:
Street Address:
Home Phone:
Work Phone:
Date of Birth:
Description of Accident:
Injuries: Yes No
Name:
Date of Birth:
Description of Injury:
Date of First Treatment:
Provider of Treatment:

AUTO CLAIM
Year:
Make/Model:
Is vehicle driveable?: Yes No
If not, where is vehicle located?:
License tag#:
Description of Damage:
Witness 1:
Phone #:
Address:
Witness 2:
Phone #:
Address: