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Filed for Record 05/04/201611 :09 :49 AM -Kittitas County , WA Auditor -201605040003 Page 2 of 12 <br />7. Describe in detail the defect which caused the injury: <br />V ~ dfd <br />8.. rrative fonn and in detail exactly how the incident occurred: <br />9. List the names of all persons involved and contact infonnation, if known. <br />10. Was claim investigated by a police officer? ___ l?-,-~Q,,-__ ~ <br />Sheriff ___ State Patrol ___ City Police <br />11. Description of claimant's vehic1e: ______ -Make.-----Year <br />Model: __________ _ License No. _____ _ <br />12. Describe what you did after the accident occurred: <br />. 13. Describe the conversations you had, if any, with County personnel during or after the <br />incident occurred: <br />20f3 <br />Kittitas County Claim for Damages Form <br />Revised 912012