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Filed for R6pV -Q8&1'212019 02:59:52 PM - Kittitas County, WA Auditor - 201908120064 Page 2 of 4 <br />7. Describe <br />in detail the defect which caused the injury: T <br />tj <br />6'9 <br />a <br />Describe in narrative form and in detail exactly how the incident occurred: <br />I war driuine e� .i on 1- b nA' 6 V couch f rQCk <br />G" LwP. pILk U Iq C M ergej ori±o I-4 0 ID : rorJ OT, me,. —1 nc+lra� 40d, <br />444W <br />roke m� <br />sAdshi end in 2.{r�c�..t , Tt�rS accurre�I an� cl i LjIS yJ 201q c,,-�' <br />List the names of all persons involved and contact information, if known. <br />10. Was claim investigated by a police officer? W O <br />Sheriff State Patrol City Police <br />11. Description of claimant's vehicle: O 1;VRO LE'r Make 119Y Year <br />12. <br />Model: (T2.0 V A t4 License No. L 3 $ `� <br />Describe what you did after the accident occurred: `r ie *rq ck <br />13. Describe the conversationsy u d 'f with Co ty personne wring or a er h <br />in 'dent occurred: " ( R tie <br />rneori r P- [ ' e eM�1 e <br />4tit -{'.orm 4o me- W ('rdry eJ me A -o conidp-+e, 464om. ad <br />re 'urn ` a spoke wA Sine Oh JU19 q,3-017 <br />14. Describe the damages or injuries which you sustained as a result of the incident: <br />2 of 3 <br />Kittitas County Claim for Damages Form <br />Revised 9/2012 <br />