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Risk Management Office

claims@charlottenc.gov

Cameron-Brown Building, Suite 1100 301 South McDowell Street Charlotte, NC 28204-2640

704-336-3301

Auto Liability Claim Form

Full Name

Full Address

Date and Time of Accident

Date Picker

Weather at time of incident

Was anyone injured?


Describe Your Vehicle

Estimate Amount

Upload estimate and/or photos

Describe Other Vehicle

Other entity


Signature

Choose how to sign