Claim Request Form

Claim Request Form

1. Claimant Information

Address *
Address
City
State
Zip

2. Occurrence or Events Giving Rise to the Claim

Was a police report filed? *

Description of Property Damage and Injuries

Witnesses

By signing you verify the information presented in this claim is to the best of your knowledge and belief.

Clerk Staff

City Clerk
Leticia Robinson
520-287-6571
lrobinson@nogalesaz.gov

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Contact Us

520-287-6571

Address

777 N. Grand Ave
Nogales, AZ, 85621

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