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Filed for Record 01/06/2011 03:45:29 PM - Kittitas County, WA Auditor - 201101060031 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 />9. Was claire investigated by a police officer? NO <br />Sheriff State Patrol City Police <br />10. Description of claimant's vehicle:tXXL --o Make Year <br />Model License No. <br />11. Describe what you did after the accident occurred: Y <br />12. Describe the conversations you had, if <br />incident occurred: <br />with County personnel during or after the <br />13. Describe the damages or injuries which you sustained as a result of the incident: <br />l <br />r <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 />C4I-fi*&WA--A - <br />Page 2 of 3 <br />