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Citizen Claims Form

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City of Tampa - Citizen Claims Form

SUBMISSION OF A CLAIM DOES NOT GUARANTEE PAYMENT BY THE CITY

Date and location must be included and accurate to consider your claim

Please format MM/DD/YYYY
Please format MM/DD/YYYY
Please format HH:MM AM/PM
Weather Conditions
Report to Police?
IF PROPERTY IS YOUR VEHICLE, INCLUDE BELOW INFORMATION
INJURY INFORMATION (If not applicable, enter N/A)
WITNESS INFORMATION
Claim Attachment(s) - Limited to 10 Attachments
Maximum 10 files.
5 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, .
18 MB limit per form.
Maximum 10 files.
5 MB limit.
Allowed types: gif, jpg, jpeg, png, webp.
18 MB limit per form.
$

The information on this form is confidential information under Florida Statute 768.28.  Any person who knowing and with intent to injure, defraud or deceive any insurer files a statement of claim or an application containing any false, incomplete or misleading information is guilty of a felony of the third degree (Florida Statute 626.8797).