Report a Claim

This Notice of Claim form is to be used to request consideration of a claim for damage; which, may have been caused by the Magna Metro Township, Utah. Each blank of this form must be filled out completely. If the information in a section of this form is not applicable, mark "N/A" in the blank. All claims should be accompanied by the actual damage costs or at least three (3) estimates from reliable sources of the projected costs to be filed with this form via email at mgnmetro@gmail.com. If additional space is needed for your response, please send the additional information via email to mgnmetro@gmail.com. Please list your name in the subject line of your email so the information can be properly added to your claim request.

For those who do not wish to use the electronic form, please download and use the attached paper form. Please attach all relevant documents. Please mail or return the the paper form and attachments to

Magna Metro Township

ATTN: Claims

8952 W Magna Main St

Magna, UT 84044

Magna is insured by the Utah Local Governments Trust for General Liability and Worker's Compensation Claims.

Supporting Documents

Downloadable Magna Notice of Claim Form (155 KB)

form.antibot { display: none !important; } You must have JavaScript enabled to use this form.

Date of filing *

Today's Date

Time *

edit-submitted-time-hour

edit-submitted-time-minute

Time AM

Time PM

Name *

Person Making the Claim

Address *

Your Home Address

Home Telephone Number *

Number can be your home telephone number or your mobile phone number, if you have no home phone number.

Work Telephone Number *

Your work telephone number

Claimed amount of loss $

Type of Loss *

Please describe the type of loss for which this claim is being filed (Ex: Bodily, Property, or Other)

Police Report *

Please provide the Police Report number (IF APPLICABLE)

Date of Incident *

Time of Incident *

Approximate time the incident occurred.

Location of Incident *

Where did this incident occur?

DESCRIPTION OF THE INCIDENT *

Please describe the time, place and manner in which the loss occurred. If the loss involves an automobile accident, show the direction, speed, point of impact, describe weather conditions and attach police report if applicable.

Description of the loss *

Please provide copies of bills and/or estimates, if available.

Report a Claim

Supporting Documents

Contact Information