Standard Form 95 is used to present claims against the United States under the Federal Tort Claims Act (FTCA) for property damage, personal injury, or death. First, however, you must file a Notice of Claim with the State (see Court of Claims Act §10).Instructions: (1) Complete this form giving specific details about your damage or loss. Submit a tort claim online securely. You can attach supporting documents and print out your submission at the end. If you believe the City is at fault for an incident or accident resulting in loss, injury or damages, you can file a claim requesting payment. Note, however, that the FTCA expressly bars claims based on any injury suffered in a foreign country, regardless of where the tortious act or omission occurred. Washington State Department of Transportation, Highway. 11. Smith, Thomas Arthur, 1234 College Way NW, Apt. New York Court of Claims. Act.
