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Filed for Record 01/06/2011 03:45:29 PM - Kittitas County, WA Auditor - 201101060026 Page 2 of 6 <br />7. Describe in detail the defect which caused the injury: A` <br />8. escribe in narrative form and in detail exactly how the incident occurred: <br />9. Was claim investigated by a police officer? <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: <br />12. Describe the conversations you had, if any, with County personnel during or after the <br />incident occurred: or 46W41/ A!P�& ,dg 5 tn4-T4(I-E <br />13. ribe the damaes or .n'uries which sustained as a result of the incident: <br />14. What is the amount of dna es claimed? (Inde es and bills, if available}: <br />�- <br />15. did you identify the County as the par responsible for your damage? <br />Page 2 of 3 <br />