Required fields are marked with asterisks (*)

Claim Report

The Town of Huntsville's claims process is located here.

Please provide/attach photos, invoices, or any other relevant documentation in support of your claim.

Note: There is a 10 day notice period for providing the Town with notice of certain types of claims and a two year limitation for bringing an action in respect to claims.

First Name

Middle Name(s)

Last Name

Name of Parent or Guardian (If Applicable)

E-mail Address

Phone Number

Unit Number

Street Number

Street Name

P.O. Box Number/ RR Number

Postal Code

Incident Information

Incident Date

Approximate Time of Incident

Incident Location

Did this Incident occur at a Town of Huntsville Facility?

Yes

Description of Incident

Emergency Personnel Attended

Fire

Paramedic

Police

Other

Not Applicable

Action Taken

Document Upload

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Witness Information

Were there any witnesses to this incident?

Yes

Claimant Declaration

By checking Yes, I am attesting that the information provided on this form is true and correct. I further understand that false or fraudulent claims cost all taxpayers and for this reason any such claims will be prosecuted to the full extent of the law.

Yes

Collection of Information

The personal information collected to investigate your claim is collected under the authority of the Municipal Act 2001, S.O. 2001, c. 29 and will be disclosed to staff and service providers who require the information to investigate your claim against the Town of Huntsville. Questions about this collection should be directed to the Municipal Clerk, The Corporation of the Town of Huntsville, City Hall, 37 Mains Street East, Huntsville Ontario, P1H 1A1. Telephone (705) 789-1751.