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Paulson NOTIC� OI' CLAIM rC)RM to the City of Saint Paul, Minnesota Miiuteso[a SicNe Stutute 4h6.05.sta/es Ilrut "•--everY Pc�rsoit...wl�o claims dcr�na�+es,%ronr mrv municipa/iry...shal/c•au.se lo be pre.renled to!he gni�erning budy o/�d�e n�unicipn(iN H�idti�� /80 d�n�s a`[er�/re a/(e�ed loss or injury is cliscovered u soirce stating!!�e tinre,place,anrl c�lrctrm.rtunces tl�ereoj,crr�d the amnunt n/��onipensa/ro�r or nther relie/'demnnded.•, Please complete this form in its entirety hy clearly typin�or printing your answer to each question. If more space is needed,attach additional sheets. Please note that you will not be contacted by telephone to clarii'y answers,so provide as nmch information as necessary to explain your claim,and the amount of'compensation being requested. You will receive a written acknowledgement once your i'orm is received. The process can take up to ten weeks or longer depending on the nuture oC your daim. This form must be signed,and both pages completed. If something does not apply,write`N/A'. SE1TD COMPLET�D FORM AND OTHER DOCUM�NTS TO: CITY CLERK, 1� WEST K�LLOGG BLVD, 310 CITY HALL, SAINT PAUL, MN 55102 Fir�t \arn� _Y'���1~ Middle Initial H Lasl Name �QC�L�vl�l R�r���ED - -_------__ __ -- - Companv c�r F3usiness Name I'�er n n 20'13 :�re l'ou an Insur�ince Company? Yes No ]f Yes, Claim Number? ERK Street Address �`'}��� ���`��_cT City ����N State 1�� Zip Code��� Dtrytime Phone �)�'�'3-��Cell Phone (� ��'� Evening Telephone (� )��� Date of Accident/Injury or Date Discovered_��' ��� _Time ���am/� Please state, in detail, what occurred (happened), and why you are submitting 1 claim. Please indicate why or how you feel the Ciry of Saint Paul or its einployees are involved and/or responsible for your damages. `�� ��f�'�r�-1�b Pl�:��e check the box(es) that most closely represent tlle re�ison for completing this form: 0 �1� ��hicle was damaged in an accident ❑ My vehicle was damaged durin� a tow � �t�� vehicle was damaged by a pothole or condition of the street ❑ My vehicle was damaged by a plow ��1� ��ehirle was wrongfully towed and/or ticketed ❑ I was injured on City property � Other t���e of ProPerty damage—please specify ❑ Other ty�e of injury—please specify In order to process your claim you need to include copies of all annlicable documents. For the claims types listed below,please be sure to include the documents indicated or iC will delay the handling of your claim. Documents WILL NOT be returned and become the property of the City. You are encouraged to keep a copy for yourself before submitting your claim form. O Property damage claims to a vehicle: two estimates for the repairs to your vehicle if the damage exceeds $500.00; or�he actual bills and/or receipts for the repairs O Towing claims: legible copies of<iny ticket issued and a copy of the impound lot receipt O Other property damage claims: two rep�►ir estimates if the damage exceeds $500.00; or the actual bills and/or receipts for the repairs; detailed lisC of damaged items O Injury claims: medical bills, receipts O Photo�raphs are always welcome to document and support your claim but will not be returned. Page 1 of 2—Please complete and return both pages of Claim Form Failure to complete and return both pa�cs will result in dcla� in the handling of your claim. To P�-ov�i►r.1F, � All Claims—n�ease comn�ete this section � Nt�T "R� 1-t71rd Were there witnesses to the incident? Yes No Unkno��n Icircle) Provide their names, addresses and telephone numbers: �T� �A C.I�IJ�� _ I�D°I°I Eb1.� U N D AV�► ST PR U.l, t�N 551 , I�aTwy C E Li, 1pl Z - b pp -�,3� �-.�El�N C�U. IOr I - �4 2-�l`18 3 Were the police or law enforcement called'' Yes \�� �nkn��N�n (cir�le► If yes, what department or agency'? Ca,� #ur rePort # Where did the accident or injury take place'? Provide street acicJresti,cross street, intersection, name uf park or t�tcilit�. closest landmark, e�c. Please be as detailed as postiible. If necesti.ir�, �III:IIII J lJl:l�f�im. �Ifip �t1C<tCk-t ED) �W I Nl� �T 13�TvVcEr1 �bMuN 17 �V�-$-c�OlV�s AV�� . Please indicate the amount you are seeking in cc�mpensation or�rhat �ou ����ul�f like the City to do to resolve this claim to our satisfaction. �Z�� �O —*OTA l.��ONL I M PL�I,V�J D LU T ` .(�.) ,D� �_�UT�F �G��T T[� �� VU I bE Vehicle Claims—please complete this section ❑ cherk h<�x if thiti tiectiem d�>e� n<�t •mnly Your Vehicle: Year_�Q� Make TlA Model Q��! License Plate Number �S �6 State M1� Color �D Registered Owner Y�I C2ST� t-t- 1�•aUl.S01`i Driver of Vehicle 1��1� — pA�Z�p Area Damaged N�� __ City Vehicle: Year Make Modcl License Plate Number State Colc,r Driver of Vehicle (Ciry Employee's Name) Area Damaged In_jurv Claims— �Icase comnlete this section O nc�ck box if thi5 �e�tic�n �i��. n,�t ��I� How were you in�ured'? What part(s) of your body were injured? Have you sought medical treatment? Yes No Pl.innin,� t�� Se�k Tr�at►n�nt �,;ircl�i When did you receive treatrnent? _ _ ___ _ iprovide d<<te(s)) Name ol�Medical Provider(s): � Address Trle�hone Did you miss work as a result of your injury'' Yes \�, When did you miss work? (provide date(s)) Name of your Employer: Address Telephone �Check here if you are attaching more pages to this claim form. \umber of additional pages�. By signing tltis fonn,you are stating tltat al[infonnalioir you ha►�e prn►•ided is trtre and correct to the best of your knowledge. U�tsig�ted forms will itot be processed. Sr�bmitting a false claim ca�: resr�lt in prosecrrtion. Date form was completed � C�� �l I ���� Print the Name of the I'erson who Com lete this F m: 1 �i f� �- 1��1/�.�s Si�nature of'Person Making the Clai ' Revised February 201 I December 9, 2013 To Whom It Mav Concern: On Thursda`�, December 5''', 2013,around lpm, my car was wrongfully towed from Aldine Street bet«�een Edmund Avenue and Thomas Avenue. I wark as a full-time nanny for the family that lives on the corner of Edmund and Aldine which is why I was in the area. I saw the towing company-PLC Recovery-pull up to my car around 12:45pm. I ran out and spoke�ith one of the men,who said I had the chance to mo�-e m��car befare it was towed,but by the time I ran into the home to get keys and come back to the car, the other male told me the car was property of Saint Paul and they would take it. He told me thc�� �t ould onh� leave the car if I paid them$75.00-cash onl��. I didn't have cash, so the car was to«ed around 1 pm. `i� understanding of snow emergency rules is pretty good-I was a Saint Paul resident for almost � ��c;ars '�1� car�cas parked on the east side of Aldine Street which is the opposite side in which the Night Plo�r Route This Side of Street sign is located. It is m_y understanding that the snow emergency parking ban for the side of the street that m��car«�as parked on��as only in effect until the road was plowed to the curb. Aldine Street in its' entiret��bet«�een Edmund and Thomas Avenues was plowed on the evening of Wednesda�•. December 4`'', 2013 -I witnessed the plow. (I worked Wednesday at the home on Edmund and Aldine and then stayed overnight due to the weather). I also made sure the street was plowed before I moved m�� car the morning of December 5`l', 2013 from Edmund Ave.to Aldine St. Aldine is generall_y plo��°ed in its� entiren�fairly immediately due to the high traffic of big trucks that use Aldine as well as for the trucking compan��(MacQueen Equipment, Inc.)tha.t resides on the corner of Aldine and Thomas. I am submitting this claim because since the street I was parked on had already been plowed I should tiOT have been ticketed or towed. I also feel that the PLC Recovery towers crossed lines when the�-attempted to pocket cash from me as well as lie to me that the car was property of St. Paul, which I no�ti kno�� to be untrue. I am asking for the entire$219.50 back from the towing and impound. I will also bc going to see a Hearing Judge to appeal the ticket. Attached are the following forms: 1. Copy� of the Citation(Front&Back) 2. Copy�of the Impound Vehicle Release Form 3. Copyo uf the Impound Lot Reciept 4. St. Paul Snow Emergency Brochure 5. Map of the Neighborhood 6. Pictures of the plowed street from both 12/5 & 12/6 to show NO change from when I«�as towed �: �: � . `� : State of Minnesota Aamsey District Court � City of � Citation# I�������������� �fi20900173934 620900173934 . --- --- - - -- _ � ! DL Numoer -_ - State � F ---------- ❑MN L�CDL � Name E Frst Middle Last -- --- ---- ----------- — ` Address-Street, Apt# ------_ — -- —-— -- -- City State Zip � DOB(mm�adlfi;�y) �� Eyes Heght � V.e�gft� ! Sex � Race � Ethnicify � ��1,� �-A.1�'1 l�Vl VV�j � � � I I Y I� �� � VehidQ Gcense No. Pfate Year � State Make I Type Model Color y �,�,,, � � , 'k ____ _� � _�_ i------1--- -_= �� ��� � �w j Date of Offense Time o'OKense —j C�AccdenUCrash -I Pe-� a _ � r ; _ Frope y _�! _ Fzta� /� f y � �� — � Parkinc Meter Num --—-- _ �— - � � F ��V�, � '�"�/�/ ber � Neighborhood Code � HousincyBuilding Code 'r _�_ ---- �- -- --—— --- --- � �� N� �'�« � � ' Booked ❑Park/dperate ❑Owner ❑Passenger ❑Driver � W . ,y— i-=- ---- ---- - _ - —- -— --- ---- � �� �� -i'�/�j'h�il � Offense Location �,� . �^/,/ StatutePDrd�nance � � ��J �� 1 w"1�� 1��� �� No t Qffense. � i i Statate.'Ord nance ` W J, , d Cp ,, L �� � N o 2 O ff e n s e IM� CNvI � � 1 � � n,A,� ,/p � No 3 Offense � S±atu!e.'Ord',nance � �� C.W��WV L � �_---- �— �� � 1,� � I,1-��4iy�-- j �Speed i69.14(subd ): mph zone — — � � ���v` �No Seat Belt Use t 69.686.1(a) �No Proof ot insurance 169.791(2) ' -- -- - `,� '^ � �C �i n r �,V� �AC Taker.-AC: Test type: ❑ Refused �; Breath G� Blood ❑ Urine ` �� �N �L� J V lVli ,, - — � � � �Hazardous Material (DOT) �Unsafe Condltions G School Zone � � ��/ �Endangering Life & Property �Woric Zone ❑Commerciaf Veh. DOT# by -ri s fi� � h fdentification: _'!DL ❑DVS Web _J Photo ID ❑Other _ C G�I/ lN��S �e°� a' _ �,� , -:,G '� I���'D►'w+ +�� ' - �rn�-� . _, . .�:�: ,� . � . . , �'fi fi y .. _ . _� . _: , . C� �iv �i��iV�� �� EOf�cer(s)Name(s) . - - ---__ _- --------- �--- ` Officer No(s). I CN# Citing Dept �How Is u�ed ���n Person _^�Mailed ❑Left at Scene !--- ---- ------- ------- L?�F�NDAi��� Tp firr!pl;f I{yC�'C�taf��i1 ic���2�,jr� �.�t,.. � .;i"':: t -?r�: ; . . . 1 �. .;.r!0�3} �'. _ ��"� #y� ';iui)SP.OI1P Of t�]£fs.lin.F t�t rTli;'t;ic� e ^fr.1;i: . -'ir . .`�7t � .,� � e k �n�rii 'I�[�J.. �� ..-_JJ� . . � . . . . .,. c .�.,. C' , :;�. . t ��". , .,fiu{i - ._.. _ _ , ._. _ iJ . . .. .;;�i,,. ��"'S�3U�i;�U '. ,, �. , '�C� , UJ.!,�O ;� �? .., . . ... . .,.- '^�. H:;.=•1. � i'iSt�IL'�(.011�: _. �,_ . , , .'.;,_.. ; �. � .. ,.� `� ___. . ... .,. ._._.. _. _.. ...._ . ._..._...__ . .. . ._. ._.._ _____._..--� ... .__.....__....... . _ t+ir1l;:,ic�n�. ��,�- ..., !�cations � , ' , :��,r La�� Fn+��rcc�re�t Ce�ter _ ._ � _ �, r 42� Gro:�a S[reet ^? a ..,_. �, ;i:i iCB S?. Paui. iv1�� �5101 .� . .�2C �.Zn r-P � ., d:,; � � _.., u �,rfays) ,,,,�� ;� , �mip.,- -.��2('� .,��2) _ _ . __ __ _ , �. :�,,� _ �.. ._�, � ":'.� �ai(� g !2[1 i� ihP i,,;��. �':IS Jv.!i?SpC['Slbtl��;/i0 �f2S8�1%OUf � � .S � p� C n� 11� CG Iat�fPa IS�dtl�d to aIi , , _ � ti�, , ;,; � , „-, _ _ .e � f �� .��th th� Co�r�, ar atld3,oral de irquert fe�r�,a;,be�-r�!��;to a':! unpa��i;�z a�?��,�r,±s. pv _,,_ - , , e�t o"r ��ni��c Saf�±y tor�irivar's�ie2nse suspensioi�, - -- - — .. _ . . .�;i cc;sed. '�. " , . �E,� "a-r'11`SC.,��P'. � d � �,� �J� tiFf ��CG.,��'E _(�� ��IE i G�i g�ii���d;l'} r2��>8!OF thE fi(�ht t0 - -, ����_ , o��; � �...a � �..��s.a ..� �, __ � �v �cor-t�,(ti^.S_16�.9i)�nd(°A.S.609.G91) _ ___._____.__._------ Appeal ?� � � �� ! e`e �,' eX6in �' `.�K �o fp�!0'.YI�g SfB�?S: �, �ft3; �� �^e�� .,, n ��1 � �oo �c:� ��.3 G�r r� ,`'c r�,° 1dt�" f1c�S 17B8f1 11�80 VJllll th8�OUf�,2lll � ,qu;, � �e�,� , _� _ __ � ,��� ra�:� a p� � :^ �. . �c� „he�meeting���ith a Hearin Of`Icer. � I urders'and thai h;� a ir this}ine I am entering a plea of�to this oftense(s)and voluntarily�^raive tne fo"oe:ing rlghts to: a. f tr�af to tf�e ceurt,if oifense is a petb,�misdemeanor, b. a tria�to fhe court or to u�ury of 6 persons,if`he ofte��se is a misdemeanor, c. reprasentafion by ceunsel,�the offense is a misdemeanor, d. a presumption of innecence u�ti!�roven guilty beyond a reasonable doubt, e. coufront and cross-examule Gi'cr�tnesses against me,aRd f. eitt�er remain s[lent or to testify in my o��rn behaif. !also understand that if this offense is a pett��misdemeanor,the maximum possib(e sentence is 5300.00; if this offerse is a mistlemeanor,the maximum possible sentence is a S1,000.00 ffne and/or 90 days imprisonmE Saint Paul Police Impound lot, 830 Earge Channel Road, Vehicle Release Form Ma�ce: 09 SATURN License#: 805CZG CN: 13258617 invoice#: 22397 Date/Time Released: 12/05/2013 20:18 Tow Charge: $ 123.95 Released to: TOTO Storage Charge: $ 0.00 Paid by: CREDIT CARD Admin Charge: $ 80.00 Refeased by: STACY Tax: (7.625%) $ 15.55 I,the undersigned,have recoversd the vehicie described above. Sub#otal: $ 219.50 p�� 1 wili check the vehiGe for damage or any other prohlems thai `! may have occurred while this vehicle was in the custody of the Service Charge: $ 0.00 � Saint Paul Police Department. I acknowledge I will report damage and/or any other prob{ems to the Impound Lot staff Total Charges: $ 219.50 on this form prior to feaving the impound lot. ' Damage and/or other problem: Police Report made: Yes_No_IF Yes, CN _, If NO, Why? TO PROTECT YOUR RIGHTS, REPORT ANY_PROBLEMSlDAPAAGE BEFORE LEAVING THE LOT Signature 5i2000 r � � r��wi trn�u,�ra�i ; �.,n Gi:k�A [ii,�;Nii ki�. `..Alhl I'Ai,l. I7t� �`.lt+:%J'.�� ebl irb S6��Z .. ,. '�J����'�.Ulti4 .. ,� i',. U��1�,:IAbu`�Unk.;'•�7.i��Nb Sale n�,.; �:F.zlzxzxzxzYo.�,� T"' Ent�Y MEthOd; Ja�19ru v_� � �itu� 1�U((k:�:�; ci..�d T3z; � ii l4i r,.+_�. g �19.�i �„a. ,, �� � lC'`��/',.Vl i,t�� n^Hi l.J.���'vy��4=1 I�r,� . r { /��Y Y�.• 1l�li� i��_,I.��N�f i�... 1 t1fiHF. I(IU� j I il �`" :_ �_�.� �ned �u�es_�o A�i_:�� �i ...__ .. 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