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Filed for Record 01/25/2016 04:59:05 PM - Kittitas County, WA Auditor - 201601250079 Page 2 of 4 <br />7. Describe in detail the defect which caused the injury: <br />a <br />J <br />10. <br />11. <br />12. <br />Describe in narrative form and in detail exactly how the incident occurred: <br />List the names of all persons involved and contact information, if known. <br />Was claim investigated by a police officer? O <br />Sheriff State Patrol City Police <br />Description of claim�1 A! ant'slveehicle: Make Q <br />Model: N License No. FI <br />Describe what you did after the accident-ocQ-=d: <br />13. Describe the conversations you had, if any, with County personnel during or after the <br />incident occurred: <br />rlmllmwtiipma 01=146,51, M611 0 awl <br />2of3 <br />Kittitas County Claim for Damages Form <br />Revised 912017 <br />