State of New Mexico Tort Notice of Claim

41-4-16. Tort Notice of Claims

A. Every person who claims damages from the state or any local public body under the Tort Claims Act {41-4-1 to 41-4-27 NMSA 1978} shall cause to be presented to the Risk Management Division for claims against the state, the mayor of the municipality for claims against the municipality, the superintendent of the school district for claims against the school district, the county clerk of a county for claims against the county, or to the administrative head of any other local public body for claims such local public body, within ninety days after an occurrence giving rise to a claim for which immunity has been waived under Tort Claims Act, a written notice stating the time, place and circumstances of the loss or injury.

Date of Incident(Required)

Time of Incident(Required)

State Agency Involved(Required)

Claimant's Name(Required)

First Last

Claimiant's Address(Required)

Street Address City State ZIP Code

Phone(Required)

Email(Required)

Location of Incident(Required)

If NM Department of Transportation, please include road, Highway #, mile marker and/or landmark

Description of Incident(Required)

Briefly describe how the incident occurred and why you feel State Agency is at fault

Claim Type(Required)

What are you making claim for? Please choose one:

Bodily Injury

Property Damage

Other Type of Damages

Briefly Describe Damages(Required)

Please retain any supporting documents pertaining to your claim

Signature of Claimant or Lawful Representative(Required)

Date(Required)

State of New Mexico Tort Notice of Claim

41-4-16. Tort Notice of Claims

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Mailing Address

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