HomeMy WebLinkAboutNotice of Claim.pdfCorporation of the District of Maple Ridge
City of Maple Ridge Notice of Claim Att: Property & Risk Manager City of Maple Ridge 11995 Haney Place Maple Ridge, BC V2X 6A9 Name: Address: Postal Code: Telephone: (Home) (Work): Date
Damage/Incident Occurred: Address Where Damage/Incident Occurred: Please accept this form as my official Notice of Claim to the City of Maple Ridge. The cause for my claim is described
as follows: As a result of the above-mentioned circumstances, I have suffered the following damage/injuries: (Indicate your cost to repair any damage and attach receipts): I fully understand
that this report must be filed with the City of Maple Ridge within two (2) months after the date on which the damage has been sustained. (Section 286 of the Local Government Act) I
understand I may obtain legal advice to further assist me with this claim. Date: Signature: