Clerk of the Board of Supervisors County of Nevada Eric RoodAdministrative Center 950 Maidu Avenue Nevada City, CA 95959-8617
In presenting any claim not founded upon contract, full details as to the nature of the claim, when and where it arose, the public property and officers or employees alleged to be at fault, the nature, extent and amount of the injury or damage claimed, and all other details necessary to a full consideration of the merit and legality of such claim shall be stated in writing, signed by the claimant or someone authorized by claimant. (For further particulars regarding filing of the Claim, see Section 900. et seq. of the California Government Code.)Warning: It is a criminal offense to file a false claim. (Penal Code Section 72; Insurance Code Section 556.1)I have read the matters and statements made in the above claim and I know the same to be true of my own knowledge, except as to those matters stated upon information or belief, and as to such matters I believe the same to be true. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
* indicates a required field