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CITY OF LATHROP CLAIM FORM FORM B Please Type Or Print CLAIM AGAINST Name of Entity Claimant s name Telephone number SS DOB Gender Male Female Claimant s address Address where notices about claim are to be sent if different from above Date of incident/accident Date injuries damages or losses were discovered Location of incident/accident What did entity or employee do to cause this loss damage or injury Use back of this form or separate sheet if necessary to answer this question in detail....
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To fill out gender as male or female, follow these steps:
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