Claim for Damages to Person or Property

Instructions for Filing A CLAIM FOR Damages 

A claim for damages to a person or property may be filled out online with electronic back up submittal, print a fillable PDF form, or pick up a form from the City of Moses Lake Administration Office located at the Moses Lake Civic Center, 2nd Floor, 401 S. Balsam St., Moses Lake, WA 98837. Please note that once you have completed the form in accordance with the guidelines below you must return the form in person or by mail to the City of Moses Lake Administration Office.


  1. The contents of this claim must comply with the City of Moses Lake Municipal Code Chapter 1.12 (PDF) or it will be deemed insufficient and rejected and will not stop the claims limitations period from running.
  2. Attach and sequentially number each additional supporting sheet.
  3. Read the entire form before filing.
  4. You must sign, date and notarize this form before submitting. If you do not, the form will be returned to you and the claims limitations period will continue to run. PLEASE NOTE: If you wish to receive a conformed copy, YOU MUST provide an extra copy of the Claim and a self-addressed, stamped envelope.

Return the complete and originally signed form to:

City of Moses Lake
City Clerk’s Office
PO Box 1579
Moses Lake, WA 98837

If you have questions, please call or email the City Clerk at 509-764-3703 for assistance.