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I Filed for Record 01/06/2011 03:45:29 PM - Kittitas County, WA Auditor - 201101060019 Page 2 of 4 <br />7. Describe in detail the defect which caused the injury: <br />8. Describe in narrative form and in detail exactly how the incident occurred: <br />se Oklopsclt�t_� <br />9. Was claim investigated by a police officer? M_ <br />Sheriff State Patrol City Police <br />10. Description of claimant's vehicle: Make . Year <br />Model License No <br />11. Describe what you did after the accident occurred: b <br />12. Describe the conversations you had, if any, with County personnel during or after the <br />incident occurred: <br />13. Describe the damages or injuries which you sustained as a result of the incident: <br />14. What is the a ount of damages claimed? (include estimates and bills, if available): <br />15. How did you identify the County as the party responsible for your damage? <br />Page 2 of 3 <br />