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-- TYPE OF CLAIM

SELECT A CLAIM TYPE BELOW:

-- TYPE OF CLAIM


-- CLAIMANT ACKNOWLEDGEMENT

BY CHECKING THIS BOX

THAT I AM NOT UNDER THE EMPLOYMENT OF THE CITY OF MCALLEN AT THE TIME OF OCCURRENCE.

-- CLAIMANT INFORMATION

* Please confirm the accuracy of these statements

-- CLAIM FOR INJURY / PROPERTY DAMAGE

In the next section describe in your own words where, when, and how the damage or injury occurred. Attach additional pages if necessary. Give names and addresses of others involved and/or witnesses, if known.

NOTE:  If any additional documents (i.e., reports, invoices, photos) are in your possession, you may fax, mail or email the information to:

City of McAllen
ATTN: Risk Management
P.O. Box 220, 78505-220
McAllen, Texas 78501
(956) 681-1410

* Please Confirm the Accuracy of these Statements

BY CHECKING THIS BOX ,

that the statements above are true and correct to the best of my knowledge on this day of 

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