Laserfiche WebLink
. i <br /> , <br /> t L If thL r.lalm Involves a veMde aaWenycolliston,piovlAc your vchldc informatlon: r�r rv� p��ka � IdMcl 1'rar <br /> N!5�--_--- • — <br /> OnYc�sNanie '�'--'A— ;h'f�';,:°utenseko. -- �uh,NaOn�nci(sI(✓�//ran!/mmdnvrr) . <br /> O�vnr�:.lnsornnmCompany <br /> 'v/I PdancNo. � Polr.ryM1'o. <br /> 12.IJames,add�esses and telcphone numbers of aR persons Involved In or wllness lo this InddenL' <br /> _��t���,,���.�-�---------- ---- --- <br /> __ _ , <br /> t3.Namcs,addmszes and lclephone numbcrs of all Clly of IEverett employces Iwvin�kno�aledgc aUout this IncldenL• <br /> 19. Namcs, .ddres,es and telephone numbeis of all Indivlduais nM aheady Identified In 7112 and !!13 above who have knowiedgc <br /> ic9aiding the Ilablllty Issuce Involvcd in Ihis Inc,ilent, m� knowleAqe of Ihr. ClalmanCs �esultln9 damage;. Please Indude a bdef <br /> JcsalpUon as lo the nnture nnd e�tent uf each pwson'S knoxledge. Altadi OdJltlonal sheels If necessary. � <br /> �e� U ���._�l�J'���'i�_t��_ lA.��—�--�'�,--'�--��e <br /> C �1��—�— �U��je+.�o� a CR ��,c�, � . <br /> - � '' - ._CL_S�EtN2 .-�f(/°��td � <br /> 1,�, �1C��bIX�__"' U <br /> I5. DescdLe the cause n(lhe Injury or damape5. Explaln tl�f proPerty lois or mediwl, pl{ys�wl or menlal Inlunes. Al4�ch <br /> aGJilional sAccls If ne�e,>ary �q / <br /> �1 � � r� 1J 3��U:t �� 1���4���U���i'�; <br /> �Zs,kUl Y! ' _ `--� '_✓LUf7�_,��� ' / j <br /> �#d.I.�0,�����/� .-�i�SS.'cv-•��. 1 _ �il���l.r. _ �(yY�}(�.�p�/� - , ,`�`7n�---���-�^��'I � <br /> �ijMi�w!LLiJ.���-r_�.�—e.�i:l_ r l� ��,G� . � �i. _Vlf-u.7�J.,/.�-1-Jr���.,.� �� �` <br /> ���S�:kcc��.c�_(��-�!W�£ _r,Jytd f c���� '' �2h,�n_Cu_t� � &1,�1 . .J���v�� I <br /> j^, }�. �ti�- ��.�,(�,r�z� -h�����-��(r����. ;����� ������ wu <br /> S,j'e t��A��"i�� �1X,�'�e��A„�' ,�S{' �J4 � C� .��-�� � ������ nlvl V�� <br /> 1��;llYls Incidcl5l�recn icuodc� u law •i rc ic ,`��y<<Y or..ecun p rn me I ro;�v ien;�n� t �v iom �j <br /> 1'/.Names,addreases nnA tclephone numbcrs of Uivtln�niedlu�t providets. Attach mples of aIl roeul.it reDorLs ancl btllin9s. <br /> 10.Plcasc allach tlncumcnLs lliat cuppcd Ihr.clalni s allcgaUons. , � / <br /> 19.I dairn Jama9es fro Ihc Clry��' cvivclt in thc swn o(f.__�RTC/n�a.Ia(/j'� `Y'0 be eCc�f�Nm�vv�� <br /> a�lomey for�lhe Cia niantS or bY 1an aillorneycal Ila�v,��lno"o['bc�i���Ico In ItmlSWle of W.sldii Ilnnl or by a Ir.oud!approved gu�Aim or <br /> 9uc�dWn ad Illcm. <br /> 1 d io under pen i of perjury tmc�r Ihe laws of Uu Slate of Washingten llial the forego!np Is irue and correcl. <br /> 9/ I�/►3 �ve��e�.,��JR ?�,��� �� <br /> ,Ip utur�Clai�ianit�� Dale Ploce si�ned (city and ate) <br /> Rov.07109 <br />