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7. Describe in detail the defect which caused the injury: <br />lCa 4t v�h cLe G t a,d ;ll m�.,..CW In <br />u.,a U <br />8. Describe in narrative form and in detail exactly°how the incident occurred: <br />1— W d, S CA -(0 JA, r � 8�„ S i � � J 5���' ; , , � } L.c� _n �1 -C'sz'.,t ._,. 1 Iyrt V1 <br />9. List the names of all persons involved and contact information, if known. <br />10. <br />11. <br />Was claim investigated by a police officer? <br />Sheriff v' State Patrol <br />Description of claimant's vehicle: <br />Model: <br />City Police <br />Make ,2 �5 Year <br />License No. \i 1 2, 18 4- <br />12. Describe what you did after the accident occurred: __rr <br />cl C� c I vt <br />13. Describe the conversations you had, if any, with County personnel during or after the <br />incident occurred: <br />((41. <br />2of3 <br />Kinitas County Claim for Damages Form <br />Revised 9/2012 <br />