Fillable Attorneys Information Personal Information Notice of Claim Against (monroe county)

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Attorneys Information Personal Information Notice of Claim Against (monroe county)

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U.S.A. forms for monroe county

BROWSE MONROE COUNTY (NY) FORMS

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Notice of Claim Against the County of Monroe
Name
Address
Home Phone Work Phone Mobile Phone
Personal Information
Date of Incident Time of Incident
Place Incident Occurred
Incident/Accident details
The nature of my claim, and the manner in which it arose are as follows: [Explain in detail.]
Nature of Claim
Please follow the Notice of Claim Instructions for the delivery of this Notice of Claim.
Name
Address
Office Phone Mobile Phone
Attorney’s Information
1
Notice of Claim Against the County of Monroe
The items of damage and/or injuries that I am claiming are as follows:
Damage and/or Injuries
Notary Public/Commissioner of Deeds Signature of Claimant
Sworn to before me this day of , 20
2
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Attorneys Information Personal Information Notice of Claim Against (monroe county)

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Completed 22 January 2021

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