Standard Tort Claim Form
Washington state law (Chapter 4.92 RCW) requires a Standard Tort Claim Form to be submitted when filing a tort claim against the Eastmont School District. Standard Tort Claim forms cannot be submitted electronically (via email or by fax), but must be mailed or delivered to the address noted below.
Required By Law
Engrossed Substitute House Bill 1553, effective July 26, 2009, requires citizens to present the Standard Tort Claim form with the government agency named in their claim. The law also requires State and local government agencies to post the Standard Tort Claim form on their websites with instructions on how to complete the form. In compliance with these requirements and for the convenience of citizens.
Legal Requirements for Presenting Standard Tort Claim Forms
In order to verify the claim and additional supporting information, the law requires that the Standard Tort Claim form be signed by:
• Claimant; or
• Person holding a written power of attorney from the Claimant; or
• Attorney in fact for the Claimant; or
• Attorney admitted to practice in Washington State on the Claimant’s behalf; or
• A court‐approved guardian or guardian ad litem on behalf of the Claimant
Present in Person or Mail the Standard Tort Claim Form and Supporting Documents to:
Eastmont School District
Attn: Garn Christensen, Superintendent
800 Eastmont Avenue
East Wenatchee, WA 98802
School Year Business Hours: Monday-Friday, 7:30 a.m. to 4:30 p.m.
Summer Business Hours: Monday-Thursday, 7:30 - 4:30 with Fridays by appointment.
Closed on weekends and official state holidays unless otherwise posted.
Instructions for Completing a Tort Claim Form
- Before presenting a Standard Tort Claim form, please read these instructions, the Standard Tort Claim form, and other appropriate forms in their entirety.
- Type or print clearly in ink and sign the Standard Tort Claim form.
- Provide all requested information and any available documents or evidence supporting your claim, such as medical records or bills for personal injuries, photographs, proof of ownership for property damages, receipts for property value, etc.
- If the requested information cannot be supplied in the space provided, please use additional blank sheets so your Standard Tort Claim form can be easily read and understood.
- The following are examples on how to complete the Standard Tort Claim Form (#SF 210):
1. Perkins, Diana Sue, 02/09/1998
2. 1234 Wildcat Way, Oak Harbor, WA 98277
3. PO Box 1234, Oak Harbor, WA 98277
4. Same (or list residence at the time of incident)
5. (509) 123-4567
7. 8:00 a.m., August 9, 2013
8. If the incident that caused the damages occurred over a period of time, please provide the beginning time and the ending time
9. Washington, Island, Oak Harbor, Oak Harbor High School, Room 123 Building number A
10. If applicable, I-5, Eastbound, Milepost 265, near the Burlington Exit
11. Oak Harbor School District #201
12. Smith, Thomas Arthur, 1234 Wildcat Way, Apt. 56 Oak Harbor, WA 98277 (360) 867-5309
13. List employee names if known or enter “Unknown”
14. List all other witnesses having knowledge of the incident in question, with their names, addresses, and telephone numbers that are not listed within items 11 and 12. Also include a description of their knowledge. For example, if your sister was with you, when the alleged incident occurred, please include her name, address, telephone number, and indicate she witnessed the incident.
15. Please describe the incident that resulted in the injury or damages, specifically answering the questions who, what, where, when and why.
16. If you reported this incident to law enforcement, safety, or security personnel, please provide a copy of the report or contact information to the person you spoke with.
17. Please provide all of your medical providers with their names, address, telephone numbers, and the type of treatment. If you were treated for a personal injury, please include your medical records and bills.
18. Attach documents.
19. Please provide the dollar amount for your damages, including your time loss, medical costs, property damage loss, etc. This amount should represent your opinion of total compensation.