Tort Claim Form

Step 1 of 4

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Email Address (optional)

Enter your email address here to receive a copy of the finalized claim. This is completely optional.

You will have an opportunity to download the finalized claim upon submission of this form.

Please see Idaho Code §6-901 through §6-929. Pursuant to Idaho Code §6-905, claims must be filed within 180 days of the date the claim arose or should have been reasonably discovered.

Claimant Information

Claimant's Name(Required)

First Middle Last

Additional Claimants

Are there any additional claimants at the same residential address?

Yes

List Additional Claimants(Required)

List the full names (first, middle, last) of any additional claimants here.

Who is filing this claim?(Required)

Claimant

Attorney

Insurance Company (Subrogee)

Parent/Legal Guardian

Claimant's Phone Number

Name of Attorney/Insurance Company(Required)

Enter the name of the Attorney or Insurance Company here.

Phone Number of Attorney/Insurance Company(Required)

Enter the phone number of the Attorney or Insurance Company here

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Inmate DOC Number (if applicable)

Claimant's Current Residential Address(Required)

Street Address City State ZIP Code

Did the claimant live at a different Residential Address for a period of six (6) months prior to the time the claim arose?(Required)

Yes

Claimant's Previous Residential Address(Required)

For a period of six (6) months immediately prior to the time the claim arose.

Street Address City State ZIP Code

Claimant Information

Incident Information

Additional Information

Finalize Claim