Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Incident Form

  1. Additional information

    Copies of medical reports, medical bills, repair bills, an estimate of damages, photographs, and any other pertinent information for this incident should be emailed to alma.roden@mansfieldtexas.gov

  2. 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.

  3. Leave This Blank:

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