Liu, JuerRevised March 2023
NOTICE OF CLAIM FORM to the City of Saint Paul, Minnesota
Minnesota State Statute 466.05 states that “…every person…who claims damages from any municipality…shall cause to be presented to the governing body of the
municipality within 180 days after the alleged loss or injury is discovered a notice stating the time, place, and circumstances thereof, and the amount of compensation
or other relief demanded.”
Please complete this form in its entirety by clearly typing or printing your answers to each question. If you have additional documentation, you may add those
documents to your submission. You will not be contacted by telephone unless clarification is needed. The claim process for investigations can take upwards of four (4)
weeks. This form must be signed, dated with all applicable sections completed. Submission this completed form to the Saint Paul City Clerk’s Office by email
(cityclerk@ci.stpaul.mn.us), fax (651-266-8574) or mail addressed to “Saint Paul City Clerk, 15 West Kellogg Blvd., Suite 310, Saint Paul, MN 55102”.
Claimant: First Name: Juer Last Name: Liu
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? YES / NO If yes, what is your Claim/File Number? _________________________
Is this claim being made by an Attorney? YES / NO If yes, what is your File Number? _______________________________________
If yes, provide your Insured’s/ Client’s Name: _______________________________________________________________________
Street Address: 2424 Territorial Rd
City: Saint Paul State: MN Zip Code: 55114
Daytime/Work Phone: __________________________________ Cell Phone: 612-404-9638
Date of Incident or Date Discovered (Must Complete): 10/2/2025 Time: 16:00
Please state, in detail, what happened that prompted you to file a Notice of Claim Form: On October 1, 2025, at approximately 3:40
PM, I parked my vehicle at 2408 Territorial Rd. The vehicle was towed by Saint Paul Police on October 2, 2025, around 4 PM under a
citation for “parking over 48 hours.”
This tow was premature. My building management confirmed that timestamped security footage exists showing the vehicle was
parked on October 1 and towed October 2; they will provide it directly to law enforcement upon request. In addition, I have verified
third-party data from my State Farm app showing the vehicle was driven at 3:38 PM on October 1, which confirms it was not parked
continuously for 48 hours.
I was therefore charged $240.24 in impound fees for an incorrect tow and request reimbursement.
Please state why or how you feel the City of Saint Paul is responsible for your Damages? The City of Saint Paul, through its St. Paul
Police Department-Parking Enforcement Division, towed my vehicle based on an incorrect assumption that it had been parked
longer than 48 hours. The objective evidence shows that was not the case, and the City is responsible for refunding the improper
impound fees.
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.
Revised March 2023
☐ 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: 25182276
If yes, what law enforcement agency responded? Saint Paul Police Department
Where did the incident take place? Please provide a street address, intersection or name of city park or facility:
2408 Territorial Rd
What would you like to see happen to resolve this claim to your satisfaction?
I request reimbursement of the $240.24 towing and impound fees that I paid on October 2, 2025, as the tow was based on an
incorrect citation and occurred less than 48 hours after parking.
Were there witnesses to this incident? Please provide names and contact phone numbers:
Shelbi Wold, 651-369-9985
For property damage claims, including vehicle accidents.
Your vehicle’s information: Year: 2007 Make: Volkswagen Model: New Beetle Color: Black
License Plate #: FCV310 State vehicle is registered in: MN
Registered owner of vehicle: Juer Liu Driver: Juer Liu
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.
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: citation copy; tow receipt;
screenshot from State Farm app showing vehicle activity on Oct 1, 2025
Revised March 2023
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: Juer Liu
Signature of Person submitting this form: Click or tap here to enter text.
Relationship of person signing to Party making the claim: SELF
Date document is being signed: 10/10/2025