Form Sh Ad 672 PDF Details

Form Sh Ad 672 is a document you may need to file if you are starting a business in California. This article will provide an overview of what this form is and what information it requires. If you have any additional questions, please consult with an attorney or your local Small Business Development Center. Thank you for choosing our blog as your source of business information.

QuestionAnswer
Form NameForm Sh Ad 672
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesfillable sheriff instructions forms los angeles, Kenneth, GOV, amazon

Form Preview Example

LOS ANGELES COUNTY SHERIFF'S DEPARTMENT

CLAIM FOR DAMAGES TO PERSON OR PROPERTY

INSTRUCTIONS:

1.Read entire claim thoroughly.

2.Fill out the claim completely.

3.This claim form must be signed.

4.Submit original signed copy.

5.Photocopies may be made for your records.

WARNING

-Claims for death, injury to person or to personal property must be filed no later than 6 months after the occurrence. (GOV. CODE SECTION 911.2)

-All other claims for damages must be filed no later than one year after the occurrence.

(GOV. CODE SECTION 911.2)

- Subject to certain exception, you have only six months from the date of written notice of rejection of your claim to file a court action. (GOV. CODE SECTION 945.6)

-If written notice of rejection of your claim is not given, you have 2 years from accrual of the cause of the action to file a court action. (GOV. CODE SECTION 945.6)

1. WHEN AND WHERE DID DAMAGE OR INJURY OCCUR?

DATE:

TIME:

STREET ADDRESS OR LOCATION:

CITY:

ZIP:

 

 

 

 

 

2. NAME(S) OF SHERIFF PERSONNEL INVOLVED:

STATION / FACILITY:

NAME:

NAME:

STATION / FACILITY:

 

TIME STAMP HERE

FOR OFFICE USE ONLY

15.WERE THE PARAMEDICS CALLED?

16.DID THE CLAIMANT VISIT A PHYSICIAN? PHYSICIAN'S NAME:

ADDRESS/(PHONE):

DATE OF VISIT:

3.DESCRIBE IN DETAIL HOW DAMAGE OR INJURY OCCURRED: (Use attachments if necessary)

4. WHY DO YOU CLAIM THE SHERIFF'S DEPARTMENT IS RESPONSIBLE?

5.LIST DAMAGES INCURRED TO DATE (Attach Copy of Receipts & Repair Estimates)

6.SHERIFF'S DEPARTMENT FILE OR REPORT#

7. NAME OF CLAIMANT (Print Clearly)

8. DRIVER'S LICENSE OR I.D. #

 

 

 

 

 

9. DATE OF BIRTH

10. SOCIAL SECURITY

11. Booking Number (if applicable)

 

#

 

 

 

 

 

 

 

 

 

 

12. CORRESPONDENCE ADDRESS - (STREET, CITY, STATE, ZIP)

 

,

 

 

,

,

 

 

 

 

 

13. HOME PHONE (or phone you can be contacted at)

 

 

14. BUSINESS PHONE

 

( )

 

 

 

( )

 

 

 

 

 

 

 

17.WITNESS TO DAMAGE OR INJURY? NAME:

ADDRESS:

CITY/PHONE:

NAME:

ADDRESS:

CITY/PHONE:

TOTAL DAMAGES TO DATE

$

TOTAL ESTIMATED DAMAGES

$

THIS CLAIM MUST BE SIGNED

NOTE: PRESENTATION OF A FALSE CLAIM IS A FELONY (PENAL CODE SEC. 72.)

18. SIGNATURE OF CLAIMANT OR PERSON FILING ON HIS/HER BEHALF:

19. PRINT OR TYPE NAME

DATE

 

 

 

 

 

 

 

 

Deliver or mail to Executive Officer, Board of Supervisors, County of Los Angeles, Room 383, Kenneth Hahn Hall of Administration, 500 W. Temple St. LA, CA 90012

SH-AD-672

How to Edit Form Sh Ad 672 Online for Free

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For you to complete this document, make sure that you provide the right information in each and every blank field:

1. First, when filling out the Kenneth, begin with the page with the next fields:

Guidelines on how to fill in applicable step 1

2. The subsequent part is to complete the next few fields: SHERIFFS DEPARTMENT FILE OR REPORT, NAME OF CLAIMANT Print Clearly, DRIVERS LICENSE OR ID, NAME, ADDRESS, CITYPHONE, NAME, ADDRESS, DATE OF BIRTH SOCIAL SECURITY, Booking Number if applicable, CITYPHONE, CORRESPONDENCE ADDRESS STREET, HOME PHONE or phone you can be, BUSINESS PHONE, and TOTAL DAMAGES TO DATE.

DATE OF BIRTH SOCIAL SECURITY, TOTAL DAMAGES TO DATE, and NAME OF CLAIMANT Print Clearly of applicable

As for DATE OF BIRTH SOCIAL SECURITY and TOTAL DAMAGES TO DATE, be sure you don't make any mistakes in this current part. Those two could be the key ones in the form.

Step 3: After rereading your filled in blanks, press "Done" and you're all set! Create a 7-day free trial subscription with us and acquire direct access to Kenneth - available in your FormsPal cabinet. FormsPal is dedicated to the personal privacy of all our users; we ensure that all personal information processed by our editor is confidential.

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