NOTICE OF CLAIM UNDER TORT CLAIMS ACT AGAINST THE TOWN OF PHILLIPSBURG,
NEW JERSEY
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(1)
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Name and post office address of the claimant;
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(2)
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Post office address to which the person presenting the claim, desires
notices to be sent;
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(3)
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The date, place and other circumstances of the occurrence or transaction
which gave rise to the claim asserted;
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(4)
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A general description of the injury, damage or loss incurred so far
as it may be known at the time of presentation of the claim;
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(5)
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The name or names of the public entity, employee or employees causing
the injury, damage or loss, if known; and
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(6)
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The amount claimed as of the date of presentation of the claim, including
the estimated amount of any prospective injury, damage or loss, insofar as
it may be known at the time of the presentation of the claim, together with
the basis of computation of the amount claimed.
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PURSUANT TO N.J.S.A. 59:8-6, DEMAND IS HEREBY MADE THAT THE CLAIMANT
PROVIDE ADDITIONAL INFORMATION OF EVIDENCE AS FOLLOWS:
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(1)
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Written reports of claimant's attending physicians setting forth the
nature and extent of injury and treatment, any degree of temporary or permanent
disability, the prognosis, period of hospitalization and any
diminished earning capacities;
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(2)
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A list of claimant's expert witnesses and any of their reports or statements
relating to the claims;
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(3)
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Itemized bills for medical, dental and hospital expenses incurred or
itemized receipts of payment for such expenses;
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(4)
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Documentary evidence showing amounts of income lost; and
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(5)
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If future treatment is necessary, a statement of anticipated expenses
for each treatment.
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NOTICE IS FURTHER GIVEN that the claimant may be required to submit
to a physical or mental examination by a physician employed by the Town of
Phillipsburg, and the claimant may be required to permit the Town of Phillipsburg
to inspect all appropriate records relating to his claim for liability and
damages, including but not limited to income tax returns, hospital records,
medical records and employment records.
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