Report and Proof of Claim

City Clerk's Office
2757 East Point Street
East Point, GA 30344

Office: (404) 270-7090 | | Fax: (404) 765-1014
Email: CityClerk@EastPointCity.org
Website: www.eastpointcity.org
Report and Proof of Claim
*Please return this form via email, fax or mail to: City Clerk's Office (see above).
Name of Claimant:*
(Individual or Business)
Date:*

MonthDayYear
Home/Business Address:*
Home/Business Telephone:*
Secondary Telephone:*
Type of Claim:*

AutomobileElectricalPotholesPropertySewageOther
If other, please explain: *
Date of Incident:*

MonthDayYear
Amount of Claim:*
Description of Claim:*
(include date, time, and location)
Name of Witness:
(if applicable)
Name of Person Completing Form:*
(if not the Claimant)
Signature*

Clear
The City of East Point does not admit that it is liable in any respect and this report and proof is required for the purpose of enabling said City to more accurately and intelligently investigate said Claim with as little delay as possible. As the Claimant, you must retain the damaged item for inspection by City personnel or an insurance adjuster if an inspection is deemed necessary. Further, additional information as to the age, condition, purchase price and place of purchase, may be required to resolve your claim. Should additional information be required to process your claim; a representative from the appropriate City Department will contact you.
Mission Statement
To provide exceptional city services in the most professional, courteous and effective manner to enhance the quality of life in the City of East Point.
Should be Empty: