HomeMy WebLinkAbout2023-01-19 CamarataProsecutor v
i Commissioner
Department
Insurance C. _
01/19/2023 04:33:45 PM 202301190022
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Claims Against County/rls/mist CAMARATA
Kittitas County Auditor
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K=rrAS COUNTY CLAIM FORDAMAGES
Return to:
County Auditor
205- W 5h Ave, 811ite 105
Ellensburg; WA 98926.
509-962=7504
Instructions:
Please read the entire form before completion. Fill out each question as completely as possible,
to the best of your ability: Do not hesitate, to use the back side of this form if you need more than
the space provided. M incomplete response may delay the processing of your claim:.
Name'(Including spouse, if married)¢
Gene'Camarata
2. Phone (Horne): ( ) (Work): ( )
3. Address (include former address if at present address for,less than.6 months):
Portland, Orgon,.If necessarywill challenge this question on privacy .and harassment}
by Kittitas. Colin-concerins at -a later time.
m"i"r General Delivery, Ellensburg, WA 98926 E -Mails gonescases@yahoo.com
yahoo.com.
GeneCamarata@gmail.com
4: Date of.Bixth: I December 26, .1.9.59 (One. or the other, or both.)
. -
(E-mail much preferred to U.S. Postal Service mall.)
5. Date and Time of Incident: —
March 16, 2016, at 3:45 PM. and/or days later still to be ascertained; I, Gene Camarata,
became aware of the incident on the afternoon of January 21, 2022.
6: Location of1ficideht: .
Kittitas County Clerk's Office, 205 W 5th AVE .Suite 210,,Ellensburg WA 98926 and `
very likely at Daily Record, 401 N. Main Street, Ellensburg, WA 98926 •
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Kittitas County: Claim for Damages Form
Revised 9/2012
Filed for Record 01/19/2023 04:33:45 PM - Kittitas County, WA Auditor - 202301190022 Page 2 of 3
Filed for Record 01/19/2023 04:33:45 PM - Kittitas County, WA Auditor - 202301190022 Page 3 of 3