Monroe County External Claim/Incident Reporting Form

Incident/Claim Information




Please insert dollar amount only.
Reporter Details
"Reporter" is the person filling out this form

"Involved Person" is an individual who is/may be involved with the claim/incident (directly or indirectly) being reported. (Examples include the claimant, witness to the Incident, lawyer, property manager, employees, etc.)
Involved Person Details

Select multiple by holding "ctrl".

Select multiple by holding "ctrl".
To add another involved person, please select "Add another response" on the bottom-right portion of this section. This will open another section where information can inserted. If not required, please ignore. 
3rd Party Involved Vehicle

Note: If you do not know the make of the vehicle, please put "N/A"

If make not known, please insert "N/A"

To add another vehicle, please select "Add another response" on the bottom-right portion of this section.

Note: There is a 25 MB per file size limit, a 35 MB total file size limit, and a 10 file limit per submission.

Please upload any supporting documents, images, invoices, or estimate of damages.

To add more than one attachment, select "Add Another Response". To remove the additional file upload option, select "Remove".

NOTE: If you do not agree, Monroe County is unable to accept your on-line form as notice about your claim.

By submitting this form, you confirm that information in this document is correct to your knowledge.