Leuthard, RachelNOTICE OF CLAIM FORM to the City of Saint Paul,Minnesota
Minnesota State Statute466.05 states that “…every person…whoclaims damages from any municipality…shallcause to be presented tothe governing body of the
municipalitywithin180days after the allegedlossor injury is discovered a notice stating thetime,place,and circumstancesthereof,and the amount ofcompensation
orother relief demanded.”
Please complete this form in its entirety by clearly typing or printing your answers to each question.If you have additionaldocumentation,you may addthose
documentsto your submission.You will not be contacted bytelephone unless clarification is needed.Theclaim process for investigations can take upwardsof
four (4)weeks.This form must be signed,dated withall applicable sections completed.Submission this completed form tothe Saint Paul CityClerk’s Officeby
email(cityclerk@ci.stpaul.mn.us),fax(651-266-8574)ormail addressedto “Saint Paul City Clerk,15 West Kellogg Blvd.,Suite 310,Saint Paul,MN 55102”.
Claimant:First Name:Rachel Last Name:Leuthard
Please Indicate Your Pronouns:☒She/Her/Hers,☐He/Him/His,☐They/Them/Theirs
Company or Business Name:____________________________________________________________________________________
Is this claim being made by an Insurance Company?NO If yes,what is your Claim/File Number?_________________________
Is this claim being made by an Attorney?NO If yes,what is your File Number?_______________________________________
If yes,provide your Insured’s/Client’s Name:_______________________________________________________________________
Street Address:1054 Burns Avenue
City:Saint Paul State:Minnesota Zip Code:55106
Daytime/Work Phone:651-494-2246 Cell Phone:651-494-2246
Date of Incident or Date Discovered (Must Complete):6/14/2024 Time:10:34 AM
Please state,in detail,what happened that prompted you to file a Notice of Claim Form:On 6/5/2024,I received an official notice
from the City of Saint Paul stating that a complaint had been filed against my property for tall grass and/or weeds,with an order to
cut and remove tall grass,weeds and rank plant growth from my yard,the boulevard and from the garage and/or alley areas.Within
the letter it was stated that a City Inspector would return within 72-hours,or on 6/8/2024,to reinspect the property.On 6/6/2024
my partner weed-whipped the yard,the boulevard,and all other areas with overgrown grass and weeds.On 6/7/2024 I went over
the grass on the boulevard with the lawn mower to cut the grass even shorter.During this period of time,there were also two
“Green Bags”placed on the grass along the boulevard waiting to be picked up by Home Depot,which were picked-up on 6/10/2024.
All grass beneath the Green Bags was flattened and brown and was in no way growing upwards.On 6/14/2024 at 10:34 AM a City
Work Crew arrived at the property and began mowing the grass along the boulevard,which had already been mowed,twice,and
proceeded to weed whip and completely decimate the Native Pollinator Garden I recently planted along the side of my house.All of
the Native Pollinator Plants &Flowers that I planted along the side of our house were weed-whipped down to nothing and
completely destroyed,along with this year’s rhubarb crop,which was thriving.The City Work Crew also weed-whipped over a
Memorial planting for a deceased animal.Additionally,the City Work Crew attempted to forcefully enter my backyard through a
locked gate and would have succeeded in doing so had I not caught them on our Ring Doorbell and yelled for them to stop.In the
process of trying to forcefully enter our gate,they caused damaged to our specialized cat fencing (which I have sent repaired)and left
our back gate ajar.This year alone,I have spent $724.32 on Native Pollinator Plants (Receipts Attached).Meanwhile,the vegetation
in our neighbor’s backyard remains taller than our shared fence,is easily 3-4’in height,remains untouched,and yet a City Work Crew
was not sent to their property.
As a homeowner,I care a great deal about the environment,particularly pollinator species,and thus participate in “No Mow May”,
meaning that I do not mow my yard or any of the surrounding area for the entire month of May.Furthermore,we received rain and
thunderstorms the first four days of June.
Please state why or how you feel the City of Saint Paul is responsible for your Damages?Despite having complied with the order from
the City of Saint Paul,the City proceeded to send a City Work Crew out to property,and said crew destroyed my Native Pollinator
Garden.I am seeking financial compensation in the amount of $724.32 so that I may replace the plants that were destroyed,and am
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seeking additional compensation for disrespecting a memorial site,in addition to causing extreme emotional distress over the loss of
my garden.
Please check the reason that most closely describes the reason for your submitting a claim.Please note the documents that will
need to be provided with your completed form.Photographs will be accepted.All documents submitted become the property of
the City of Saint Paul and shall not be returned.
☐Automobile damage from a motor vehicle accident:please provide two estimates for repairs or actual bill that has been paid.
☐Automobile damage from a street defect or pothole:please provide two estimates for repairs or actual bill that has been paid.
☐Automobile was towed and may or may not have sustained damage:please provide copy of towing ticket (if available),receipt
from Impound Lot,and two estimates for repairs or actual bill that has been paid.
☐Snow Emergency:please provide copy of towing ticket (if available),receipt from Impound Lot,and two estimates for repairs or
actual bill that has been paid.
☐Property damage:please provide two estimates for repairs or actual bill that has been paid.
☐You were injured during a motor vehicle accident:please provide police report number,details about injury.
☐You were injured in the City of Saint Paul:please provide police report number,witnesses,and details about injury.
Continue to page 2 of Notice of Claim Form.Failure to complete and return both pages will result in delays.
This section must be completed for all claims.
Is there a police report for this incident?YES /NO
If yes,please provide the police report case number:___________________________
If yes,what law enforcement agency responded?____________________________________________________________
Where did the incident take place?Please provide a street address,intersection or name of city park or facility:
____________________________________________________________________________________________________________
What would you like to see happen to resolve this claim to your satisfaction?
____________________________________________________________________________________________________________
Were there witnesses to this incident?Please provide names and contact phone numbers:
____________________________________________________________________________________________________________
For property damage claims,including vehicle accidents.
Your vehicle’s information:Year:_________Make:_________________Model:__________________Color:__________________
License Plate #:_________________________State vehicle is registered in:___________________________
Registered owner of vehicle:_____________________________Driver:__________________________________________
Area(s)damaged:______________________________________________________________________________________
If a City vehicle was involved,License Plate #:_________________________________Color:_______________________________
Was there City insignia on the vehicle?YES /NO Driver’s Name:______________________________________________________
Other property damaged:_______________________________________________________________________________________
For injury claims of any type.
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What part of your body was injured?_____________________________________________________________________________
Did you go to the emergency room or urgent care?YES /NO Where?___________________________________________________
Was medical treatment received?YES /NO Where?________________________________________________________________
First day of medical treatment?_____________Are you still receiving medical treatment?YES /NO
Did you miss any work as result of this incident?YES /NO
Employer(s):_________________________________________________________________________________________________
How much time have you missed from work?_____________________________________________________________________
If you are submitting other documents,please state what you are attaching and how many pages:5 Pages Including Proof of
Compliance &Receipts for Reimbursement +Photos of Neighbor’s Yard as it Currently Exists on 6/20/2024.
By signing this form,you agree that all information provided is true and correct to the best of your knowledge.
Please NOTE that submitting a false or misleading claim can and will result in prosecution under Minnesota Statutes.
Name of Person completing form:Rachel Leuthard
Signature of Person submitting this form:_______________________________________________________
Relationship of person signing to Party making the claim:__________________________________________
Date document is being signed:_____________________
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