1. (a) A claimant shall prepare a claim by:

   1. (1) Completing the claim form described in (b) below; and
   2. (2) Attaching the documents described in (c) below.

2. (b) The claimant shall provide the following information on a claim form furnished by the secretary of state:

   1. (1) The name and address of the claimant;
   2. (2) The name and address of the attorney for the claimant, if any;
   3. (3) The name of the agency claimed against;
   4. (4) The date of the incident giving rise to the claim;
   5. (5) The amount claimed;
   6. (6) The circumstances surrounding the claim; and
   7. (7) The claimant's theory of liability.

3. (c) The claimant shall attach to the completed claim form copies of:

   1. (1) Bills and receipts supporting the amount claimed; and
   2. (2) Any other relevant documents supporting the claim.

Source. #8511, eff 12-09-05, EXPIRED: 12-9-13