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Get And Sign CITY OF UPLAND CLAIM FOR DAMAGES Uplandpl lib ca us Uplandpl Lib Ca Form

CONTINUE ON PAGE 2 CLAIM MUST BE SIGNED ON THE REVERSE SIDE PAGE 1 The amount claimed as of the date of presentation of this claim is computed as follows Damages incurred to date exact Damages to property Expenses for medical and hospital care Loss of earnings Special damages For General damages Total damages incurred to date Estimated prospective damages as far as known Future medical and hospital expenses Future loss of earnings Prospective special damages Other prospective special damages...

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