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Filed for Record 01125/2016 04:59:08 PM - Kittitas County, WA Auditor - 201601250079 Page 2 of 4 <br />7. Describe in detail the defect which caused the injury: <br />S. Describe in narrative form and in detail exactly how the incident occurred: <br />Se a <br />-47 <br />9. List the names of all persons involved and contact information, if known. <br />10. Was claim investigated by a police officer? <br />Sheriff State Patrol City Police <br />11. Description of claimant's vehicle: & Make <br />Model: License No.� <br />-- 12. <br />Year <br />y <br />13. Describe the conversations you had, if any, with County personnel during or after the <br />incident occurred: <br />4W Oo k- -�o r A& A�� K4 g COt J Id �(Vj <br />2 of 3 <br />Kittitas County Claim for Damages Form <br />Revised 912012 <br />