Claim Forms

To File a Notice of Claim at the Town of Prescott Valley:

Complete a Notice of Claim form below. Forms may also be printed from the links below or obtained from The Town Clerk department in the Civic Center.

Completed Claim forms are to be submitted to:

Town Clerk's Office
7501 E Skoog Blvd, Room 216
Prescott Valley, AZ 86314

Call 928-759-3135 or email the Town Clerk for further information.

claim forms stock shot
  1. Notice of claim form (english)

Notice of Claim (english)

  1. NOTICE OF CLAIM AGAINST THE TOWN OF PRESCOTT VALLEY
  2. CLAIMANT INFORMATION
  3. OCCURRENCE OR EVENTS GIVEN RISE TO CLAIM
  4. Was this a vehicle accident?*
  5. Was a Police report filed?
  6. Description of Property Damage and Injuries
  7. WITNESSESS
  8. By signing/entering your name below, you verify the information presented in this claim is true to the best of your knowledge and belief.
  9. Please fill in all information requested above or your notice of claim may be deemed defective. All notices must be signed and dated. The Town must also indicate above, the date and time received.



    THE ARIZONA MUNICIPAL RISK RETENTION POOL AND SOUTHWEST RISK SERVICES ARE NOT AUTHORIZED AGENTS TO RECEIVE ANY NOTICE OF CLAIM UNDER A.R.S. §12-821.01. ALL NOTICES OF CLAIM MUST BE LEGALLY SERVED ON THE TOWN AND ON EACH INDIVIDUAL WHOM YOU CLAIM TO BE RESPONSIBLE FOR YOUR INJURIES OR DAMAGES. THIS FORM WAS CREATED FOR YOUR CONVENIENCE. HOWEVER, THE TOWN THAT IS PARTY TO THIS MATTER DOES NOT WAIVE ANY OF ITS RIGHTS OR DEFENSES FOR YOUR FAILURE TO COMPLY WITH ALL NOTICE OF CLAIM REQUIREMENTS ESTABLISHED BY ARIZONA STATUTE AND LAW. UNDER A.R.S. §12-821.01, YOU ARE REQUIRED TO STATE YOUR DAMAGES WITH A SPECIFIC DOLLAR AMOUNT FOR WHICH YOU WILL SETTLE YOUR CLAIM AND, TO SUPPORT THAT AMOUNT WITH EVIDENCE. YOUR NOTICE OF CLAIM WILL BE DEEMED DEFECTIVE WITHOUT THIS INFORMATION.

  10. Leave This Blank:

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

  1. Aviso de Damanda (espanol)