Tort Claim Against Kansas Municipality


Before submitting this tort claim, read Procedures Required by Kansas Statutes and Presenting a False Claim.

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Claim Type and Basis of Claim
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Signature of Claimant
I certify that I have read "Procedures Required by Kansas Statutes" (located at top of page) pertaining to this Tort Claim. I hereby attest and affirm, under penalty of O.M.C. 9.09.030 or K.S.A. 21-6004 "Presenting A False Claim" (located at top of page), that the above information, including any attachments, is true and accurate to the best of my belief and knowledge.