Should a private citizen incur personal injury, death or damage to property, as provided in the Good Samaritan Act, the private citizen or a person dependent upon such citizen for principal support may file a claim in the office of the Governor for indemnification to the extent that the claimant is not compensated from any other source for such injury, death or damage. The claim shall state:
The claim shall be accompanied by a corroborating statement.
Okla. Stat. tit. 76, § 5.2