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114 <br />Filed for Record 01/06/2011 03:45:29 PM - Kittitas County, WA Auditor - 201101060027 Page 2 of 3 <br />7. Describe in detail <br />8. Describe in narral <br />ect ch c <br />ve form and in detail <br />the iniurv: <br />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: Af - 14 lAtW <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 incl t:. <br />14. W's the <br />if available): <br />