DAMAGE MUST BE CAUSE BY CONTACT WITH THE TRUCK, NOT SNOW

**Installation of the box and/or post is the responsibility of the claimant**

**Mailbox should be placed a minimum 14 feet from the center line when possible. Single mailboxes should be installed on a 4x4 or 4.5-inch diameter wood post or steel post no greater than a standard 2-inch diameter. Mailboxes should be at a height of 41 to 45 inches. **

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Mailbox Claim Form

Date Field*

Your First Name*

Your Last Name*

Email*

Phone*

Address*

Please check all that apply:*

Damaged Mailbox

Damaged Post

Comments:

Road Commission Use Only!

Claim Approval/DenialClaimant accepts cash payment as following:_____ $25.00 for Mailbox_____ $20 for Post Signature:______________________________________ Date:_________________________ Comments:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________