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Mailbox Replacement Claim

  1. Incident Location*

  2. MM/DD/YY

  3. Police Report Completed

    If yes, upload a copy of the police report.

  4. Repair/Replacement Options*

    For reimbursement, upload copies of receipts.

  5. Certification

    I understand that if the City deems my mailbox damage to have been caused by a City snowplow, I may choose to have my mailbox repaired or replaced by the City or be reimbursed for the cost of my repair/replacement "in kind" mailbox in an amount no to exceed $100. I further understand that I have 30 days after the event in which to file a claim for repair/replacement of my mailbox.

  6. Acknowledgement*

  7. Leave This Blank:

  8. This field is not part of the form submission.