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IL lf Ws dalm Involves a veBldo aalAent/ml8slon, nrovidc your veulcle Intorcnatlon: paro Na � nx rc � M�do� ✓�+� <br />DArcA�Nama . <br />/HrYc�ifltrnro!'o. Vrh(daOwna(s)n(di/hmrtfMmdnVei) <br />OxneiY fas�ian�e Colt�e.ony <br />FhonoNo, a'��h�"` <br />12. Naines, addres:es and le!eplmne numbners of ali pasons InvolvM In nr� Itn �o thls�riddent: <br />. ,.. JY� ! �� .. IY. r� Q/li Vri I I n 1 1 w G (,.�/Yl __ <br />13. Names, addressus anr' telephonc mmibers o( nll Cily of C•vemlt emplo��ees hav6i� knowkdpe abo.R GUs Intldent: <br />14, Nomcs, adAresxs and telephonr. mmibers nf all Indlvlduals nol atreaJy Itlenlllied In p12 nnd 7;�3 utwve who have Miowtedpc <br />d Sa �Itlon,�stlo h'Ie nelure und evitent oi each pe�rson's�knowledge � Alloch1addl lonal sh c�s Iflnacssnry,9°s. Niease Inclode n bdeP <br />15. pesal6e the tnuse nf Ihe InJury u� damages. Fxplala tlir. eMenl nf propedY loss or medlwl, physl�il ar mental INudes, Altach <br />aAdlllonal4heeLslfneressary. „ ,, . ' , _� .. ,,. ._ A r. � n�n,� . . _ .. <br />l4. Ha hls hiddent bcen rep�ldedWo law enforcemM�cnfety or recudty personnM7 If so, when . nd �� wliam? <br />17. PJameS� 0ddre55Cs nnd leleptumn tmmbrvs nf Btallnp mcdlwl provlderr,. Atlnth NpIC90f nll tnedlrnl fe�ods tmd lilllings. <br />10. Plca+c allach dowmenL lhat �uVP��« Ihc rlalm's al'egaUans. . �, . <br />t7.ldalmdama9c.fromlhcCltynfl:verr.ttlnlhoeumof$_L�� ���-1-'�Isrnll/1�Q(� <br />Thls chlm fotm mwt �e e�ln��ed by elUier tlr. Galmant or on Nehall of the Galmant bY un oUmnoy�fmfact :vho holds a wdlten �wr+er ot <br />altorncy for lho Clnlmanl, or hy an atlornoy at Uw admilted ln prndl�� In the Stale oi Wasltln9ton, ur Ly a cowta{Mroved guardlan or <br />�uardlnn ad Illein. � � <br />I dedare unAer pcaalry o! porjury under Um laws of Il;e State of Washinglon �hat the foregolu9 U trae und :onect, <br />����� �'�..,��j _ ��_ � _L`; _ � t.�. � - � <br />f_i_ �'-.R� ptaco slgna (cIW nnd eUto) <br />Slgnaluribjof Gtalmant Det� <br />Rov, D77GN �' <br />