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Filed for Record 03/06/2017 11:19:05 AM - Kittitas County, WA Auditor - 201703060010 Page 2 of 8 <br />7. Describe in detail the defect which caused the injury: <br />e <br />�g& <br />iwa,K� % 3 <br />(t i -u r�� <br />Kc`tfi � 6t -a CC-)UAty <br />L1, <br />'pe \ <br />flhc�rceci <br />kik 0 tip e <br />1`QY� ' At the <br />}� Q eK o� ✓h `t� <br />ea. <br />Describe in narrative form and in detail exactly how the incident occurred: <br />9. List the names of all persons involved and contact information, if known. <br />Rcoj rke; c',a%_ 5%5-01iV l <br />Ar�te�. ���me 5�� —g62— X4525 <br />!&hevkffs 'Pg$v04 Sargent 501- T62 ..'52'S <br />10. Was claim investigated by a police officer? E$ <br />Sheriff State Patrol X City Police <br />11. Description of claimant's vehicle: i'A ereehos '6eav--. Make 2 0 V9 Year <br />Model: M\ -I-) ISO License No. PkU ? gOoO <br />12. Describe what you did after the accident occurred: <br />with PANdcec,. gku°ae VA 40CAot- 4, C- vQ(65 <br />Vemelt IN�ter e,trh� i �� it��&Vft ikon and qe �(1q aA <br />`� txeh��ge dF l\\�LXVM't'ao'�� F� n\ 3PCom OkEceQ FeCCekt�t�� ueel on s +Uau <br />13. Describe the conversations you had, if any, with County personnel during or after the <br />incident occurred: <br />`ik\C- cowni-t o-ecsonaei O.c we-�A 'Lt mas, their Vixok-f (t <br />+AA tie (,t%c+ -tiv h ) A. Rksir, Pw 4 , <br />2 of 3 <br />Kittitas County Claim for Damages Form <br />Revised 9!2012 <br />