Tort Claims

Tort Claims

TORT NOTICE MUST BE FILED WITH THE CITY OF FISHERS, INDIANA, WITHIN 180 DAYS AFTER THE LOSS OCCURS.

Name of Claimant*

Street Address of Claimant*

City of Claimant*

State of Claimant*

Zip Code of Claimant*

Claimant Email Address

Phone Number of Claimant*

Phone

Date of Loss*

Time of Loss*

Ensure to put A.M. or P.M. if using standard time.

Description of Circumstances*

Extent of loss being claimed*

Names and contact information of all persons involved, including witnesses*

Amount of damages being claimed*

Number only

Agreement of Terms and Electronic Signature

By typing your name in the box below and hitting submit you are acknowledging your agreement with the terms stated in this document and further certifying that checking the box counts as an electronic signature. Your electronic signature is considered legally binding the same as signing your physical signature by hand (IC 26-2-8).

Claimant Signature*

Additional Claimant Signaure

If Applicable

Attachments

Drag and drop files here or

Questions?

City of Fishers

Legal Department

OneMunicipal Drive

Fishers, IN 46038

bennettl@fishers.in.us

This tort claim form is subject to the Indiana Access to Public Records Act.

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