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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.