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Filed for Record 01/06/2011 03:45:29 PM - Kittitas County, WA Auditor - 201101060020 Page 2 of 4 <br />i <br />7. Describe in detail the defect which caused the injury: _ �e &. ta(.� <br />I <br />8. Describe in narrative form and in detail exactly how the incident occurred: <br />I <br />9. Was claim investigated by a police officer? iV 0 <br />Sheriff State Patrol City Police <br />14. Description of claimant's vehicle: Make Year <br />I <br />Model License No. <br />11. Describe what you did after the accident occurred: rl Ot aa W red �rc <br />12. Describe the conversations you had, if any, with COurn personnel during or after the <br />incident occurred: u r & tou S of <br />13. Describe the damages or injuries which you sustained as a result of the incident: <br />1rP,0/1_i +( rfid-S Pfd, i von injuries <br />Ak, *.1 rJ1)f1 f ► !1 cc ^a n„ <br />5 � 1�.' ► afAm at <br />.� nk e . <br />14. What is the amount 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 />