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  1. BlkJenksLogo

  2. City of Jenks
    PO Box 2007
    211 N Elm St Jenks, OK 74037

  3. The filing of this form with the Jenks City Clerk's office is only the initial step in the claim process and does not indicate in any manner the acceptance of responsibility by the City of Jenks or its related entities. This form is required by law and shall be filed with the City Clerk within one (1) year from the date of occurrence. Failure to file within such time frame may result in the claim being barred in its entirety.

  4. Was the occurrence reported to any City department?*

  5. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

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  7. This field is not part of the form submission.