ST9302-CL000831LAWSUIT/CLAiMS AGAINST THE CITY TRANSMITTAL FORM
DATE:
FROM:
DISTRIBUTION LIST:
/ Jim witt, City Manager
Peter O.Smith, City Attorney
~ Vivyon Bowman, Director of Human
R~sources
Texas Munlcipal League
Lawsuit File (original/copy)
,/'
COWIMEIh'TS:
suit/city.form
revised 8/19/94
CLAIM NOTICE
PLEASE USE BLACK INK ONLY
(For Office Use)
City Secretary
Copp~pp TX 75019 ~,o~,~~_~ ~ . ~ , '
TMs is m~otice of cl~ ag~st the Ciw of CoppeH. The c~cu~t~ces ~mg n~ to ~ ~1~ ~e ~
fo.o : X -.
1. ~(~u~ or ~age o~ff~ on ~e ~ / ~y of ~ "> ~ ,
at appro~dy ~ &~ o'clock ~e~cl~ono[ ffk/ $~
~~ ~ ~/~ , h Copp~ T~.
2. The d~ag~ or occu~ed ~ ~e foHo~8 ~:
The full extent of my
etc., if available): _~
(Please Print)
Address
The amount of damages claimed is $__
and/or injuries_are ~ follows (b...e specific - attach 9stimates, bills,
,d
I do swear the above is tree and correct.
/
Arti& 11, Section 11.09 of the Home Rule (~harter - Damage Suits.
NOTE:
filed within forty-five (45) days of the date of injury or damage or, in the case of
(45) days of the date of death. The failure to so notify the City within the thne and
exonerate, excuse and exempt the City from any liability whatsoever. No action at
against the City until at least sixty (60) days have elapsed following the date of notification.
notification shall be
within forty-five
specified shall
be brought