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Notice of Injury and Claim Form Wisconsin Department of Justice Doj State Wi

Notice of Injury and Claim Form Wisconsin Department of Justice Doj State Wi

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Except as to those matters stated upon information and belief and as to those matters I believe the same to be true. Claimant s Name Address Phone Time and Date of Occurrence Location Statement of Circumstances Giving Rise to the Claim for Such Injury Damage or Death and Names of Persons Involved Including Name s of State Officer s Agent s or Employee s. Stat. Section 893. 82 This notice must be served upon the Attorney General by certified mail within 120 days of the event giving rise to the...
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