Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Citizen Request to File a Claim

Steps

  1. 1. Step One
  2. 2. Occurrence Information
  3. 3. Insurance Information
  4. 4. Witness Information
  5. 5. Agreement
  • Step One

    1. This form is to be completed by the Citizen filing a claim for damages or reimbursement from the Town of Mooresville. Please complete all applicable information and be as specific as possible. Attach any documentation available (i.e. Police Report, invoices, bills, estimates, photographs, etc.). If estimates are attached, two (2) independent estimates for repair / maintenance must be provided. This information will be provided to the Town’s insurance adjusting firm for investigation and disposition of the Claim.

    2. BY SUBMITTING THIS FORM, THE TOWN OF MOORESVILLE IN NEITHER ACCEPTING NOR DENYING LIABILITY OR RESPONSIBILITY FOR THE OCCURRENCE DESCRIBED BELOW. AN INVESTIGATION WILL BE CONDUCTED BY THE TOWN OF MOORESVILLE. FURTHER INFORMATION MAY BE REQUIRED FROM THE CLAIMANT. THE CLAIMANT WILL BE NOTIFIED BY MAIL AS TO THE FINAL DISPOSITION OF THE CLAIM BY THE TOWN'S INSURANCE ADJUSTING FIRM.