Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Notice of Claim Against Seaside Form

  1. Instructions

    (Please read carefully): Claims related to injury to person or damage to personal property must be presented to the City within six (6) months from the date of loss. Claims related to any other loss must be presented not later than one (1) year from the date of loss. Answer all items fully and to the best of your knowledge and information. Failure to do so may result in your claim being found insufficient. If more space is needed to provide requested information, please attach additional pages identifying paragraph(s) being answered. Any questions about claim submissions, can be directed to 831-899-6703.

  2. Please Select Which Agency you are filing the Claim Against*

  3. Claimant's Mailing Address

  4. What amount of money are you seeking to recover?*

  5. May we direct all notices and communications with regard to this claim to the Claimant shown above?*

  6. Confirmation

    I/We, the undersigned, declare under penalty of perjury that I/We have read the foregoing claim for damages and know the contents thereof, that the same is true of My/Our own knowledge and belief, save and except as to those matters wherein stated on information and belief, and as to them I/We believe to be true.

    (Note: If someone files the claim on behalf of the claimant, the person making the claim on behalf of the claimant should sign below.)

  7. Fraud Warning

    WARNING: PRESENTATION FOR ALLOWANCE OR PAYMENT OF A FALSE OR FRAUDULENT CLAIM, WITH INTENT TO DEFRAUD, IS A CRIME PUNISHABLE AS A FELONY UNDER CALIFORNIA PENAL CODE, SECTION 72, AND INSURANCE CODE, SECTION 1871.1.

  8. Leave This Blank:

  9. This field is not part of the form submission.