Proof of Claim forms must be received by April 1, 2020 to be eligible.

You must fill out all five sections of this Proof of Claim to be eligible for a refund.

If your Proof of Claim is incomplete, you will receive a credit on your private fire line account, but you will not receive a refund check.

Claim Members Name(Required)
Current Mailing Address (This is the address where we will send your refund check)(Required)
You must enter the service address here (This is the address of the property that received private fire line service)(Required)
List the period in which you were billed and/or paid for Private Fire Line Service in order to participate in the settlement. Please submit a separate claim form for each property for which you were billed.
Date Range From:(Required)
Through:(Required)
By submitting this claim form, I swear or affirm under penalty of perjury that I am, or am an authorized agent of, the owner of the property which was billed and/or paid the City for Private Fire Line Service at any time between July 1, 2017 and December 31, 2019.
Today's Date(Required)