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2016 Form Wwwrevenuealabamagov Ala Bam a 40

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_________________________, ____________ ____________________________________________________________________________________ ____________________________________________, AL ________ Re: ________________________Dear ________________________:Pursuant to Title 11-47-23, Code of Alabama, 1975, as amended, please consider this letter to be notice of a claim by ________________________________ against _______________________________. WHEREFORE, _________________________________ claims compensatory damages in the amount of $_____________________.Sincerely, ________________________________________________________________________ STATE OF ALABAMA *_____________ COUNTY *Before me, the undersigned authority, a Notary Public in and for said state and county, personally appeared ___________________________, who is known to me, and who, being by me first duly sworn, deposes and says on oath that the matters and things alleged in the foregoing are true and correct. SWORN TO and SUBSCRIBED before me this the _____________ day of _____________, ________. ______________________________ NOTARY PUBLIC Received by: __________________________Date: ________________________________

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