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Filed for Record 12/29/2017 11:45:18 AM - Kittitas County, WA Auditor - 201712290016 Page 2 of 16 <br />7 <br />0 <br />Describe in detail the defect which caused the injury: VO I'?- C c3"o "T) 'J'e -0— S -td aeci <br />outs, &c Tom -Pav i 1\o n -For c1 horse. ShoalA -I-Mck arid, <br />. i F . I A .. .. i <br />chkIcl <br />korse <br />J <br />Describe in narrative form and in detail exactly how the incident occurred: <br />9. List the names of all persons involved and contact information, if known. <br />2551 Get f�}� CI�f:Z,l rl - I ' 2 5 -`7y `i - U( _,PQ I <br />J o e e SVA -en u -ex" - 501- q 2 5- &30 3 <br />5 - 3�?-, a. 3'- 4'1Do <br />10. Was claim investigated by a police officer? <br />Sheriff State Patrol City Police <br />11. Description of claimant's vehicle: Make Year <br />Model: <br />License No. <br />12. Describe what you did after the accident occurred: <br />EK visk`-�- <br />13. Describe the conversations you had, if any, with County personnel during or after the <br />incident occurred: <br />No conn ci- <br />2 of 3 <br />Kittitas County Claim for Damages Form <br />Revised 9/2012 <br />0 rl <br />