Bowker, Deborah RECEl4'EC�
JUL 11 2014
NOTIC� OF CLAIM FORM to the City of Saint Paul, Minnesota
CITY CLERK
Mi�ulesota S�rue Stutute 466.05 states tlue� "...every person...�vhn clnims dnmages.�'ront nny numicipnlity...slrnll cau.re ro he pre.scnted to d2e
governing budy uf tire municipnlity x�ithi�i 180 du��s nfter the alleh�ed/oss or injury is discovered a notice stnting the time,p/ace,a�1d
circuntstances 1/tereof,and dre nmowrt of contpensntian or other relief demnncfed."
Please complete this form in its entirety by clearly typing or printing your answer to each question. If more space is
needed,attach additionat sheets. Please note th:�t you will not be contacted by telephone to clarify answers,so provide as
much information as necessary to explain your claim,and the amount of compensation being requested. You will receive a
written acknowledgement once your form is received. The process can take up to ten weeks or longer depending on the
n�ture of your claim. This form must be signed,and both pages completed. If something does not apply,write`N/A'.
SEND COMPLETED FORM AND OTHER DOCUM�NTS TO: CITY CLERK,
15 WEST KELLOGG BLVD, 310 CITY HALL, SAINT PAUL, MN 55102
First Name �� �n ��.h Middle Initial f7" Last Name �E.J o G✓� 'P�
Company or Business Name
Are You an Insurance Company? Yes/�c ' If Yes, Claim Number?
Street Address � �' �� /��� '� ��
Cit � � �a✓� State � � n r� Zip CodeS� ��
y
Daytime Phone (�`��) 7� � �G 1 Cell Phone ( ) - Evening Telephone( ) -
Date of Accident/Injury or Date Discovered� /�, o i ? Time am pm
Please state, in detail, what occurred (happened), and why you are submitting a claim. Please indicate why or how you
feel the City of Sa.}nt Paul or its empl/�yegs are involved a d/or res onsib)e fo�your damages.
�`r � f U r..�L d L�Y1 "/ +Q �.���_�o�r k ec
Please check the box(es)that most closely represent the reason for completing this form:
❑ My vehicle was damaged in an accident ❑ My vehicle was damaged during a tow
❑�ICy vehicle was damaged by a pothole or condition of the street ❑ My vehicle was damaged by a plow
�My vehicle was wrongfully towed and/or ticketed ❑ I was injured on City property
❑ Other type of property damage—please specify
❑ Other type of injury—please specify
In order to process your claim You need to include copies of all apnlicable documents.
For the claims types listed below, please be sure to include the documents indicated or it will delay the handling of
your claim. Documents WtLL 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 the actual bills and/or receipts for the repairs
O Towing claims: legible copies of any ticket issued and a copy of the impound lot receipt
O Other property damage claims: two repair estimates if the damage exceeds $500.00; or the actual bills
and/ar receipts for the repairs; detailed list of damaged items
O Injury claims: medical bills, receipts
O Photographs are always welcome to document and suppoR your claim but will not be returned.
Page 1 of 2—Please complete and return botli pages of Claim Form
Failure to com�lete and return both pages will result in delay in the handling of your claim.
All Claims—�lease cc►mnlete this section
Were there witnesses to the incident? Yes .N Unknown (circle)
Provide their names, addresses 1nd telephone numbers:
Were the police or law enforcement called?r Ye� � No Unknown (circle)
If yes, what department or agency? � �o �c Case#or report#
Where did the accident or injury take place? Provide street address,cross street, intersection, name of park or facility,
closes landmark, etc. PI se b as detailed as ossible. If necessary, attach a diagram. �2�S I.�l� r�,�'�c
f�,� � S% ��.,, � f✓'� �S$�� 9
Please indicate the amount you are see� ng in compensation or what you would like the City to do to resolve this claim
to your satisfaction. '�r� �iv ( �c��S�C �-l�T� S�0
Vehicie Claims—nlease complete this section ❑ check box if this section does not a�ly
Your Vehicle: Year Make Model
License Plate Number State Color
Registered Owner
Driver of Vehicle
Area Damaged
City Vehicle: Year Make Model
License Plate Number State Color
Driver of Vehicle (City Employee's Name)
Area Damaged
Injury Claims—please complete this section ❑ check box if this section does not a�ply
How were you in�ured?
What part(s)of your body were injured?
Have you sought medical treatment? Yes No Planning to Seek Treatment(circle)
When did you receive treatment? (provide date(s))
Name of Medical Provider(s):
Address Telephone
Did you miss work as a result of your injury? Yes No
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. Number of additional pages
I3y signing tliis form,yorc are stating that all information you have provided is true and eorrect to the best
of your knowledge. Unsigned forms will not be processed.
Submitting a false claim can result in proseciction. Date form was completed /� a O l
Print the Name of the Person who Completed this Form: f�✓5 c?�.,/�� �',r—
Signature of'Person Making the Claim: - "�-'
Kevised February 201 I
STATE OF MINNESOTA O RD E R DISTRICT COURT
COUNTY OF RAMSEY SECOND JUDICIAL DISTRICT
TO REPORT
CITY OF VIOLATION FILE NO.
ST PAU L 620900203760
DEFENDANT'S PHONE NO.
DEFENDANT
Deborah Bowker 651-714-2767
YOU, THE ABOVE NAMED DEFENDANT, ARE ORDERED TO APPEAR ON:
.1u11. 16, 2014 at 1:00 PM for COURT TRIAL before the presiding judge in room# 130.
FAILURE TO APPEAR FOR A SCHEDULED COURT APPEARANCE IS A CRIMINAL OFFENSE
UNLESS FAILURE TO APPEAR IS DUE TO CIRCUMSTANCES BEYOND YOUR CONTROL.
FAILURE TO APPEAR FO APPEAR W�ITH NE 0 DAYOS A DUSHOW'THE FOAISURE TO APPEAR OF GUILTY
UNLESS YOU
WAS DUE TO CIRCUMSTANCES BEYOND YOUR CONTROL.
�== FAILURE TO APPEAR MAY RESULT IN A WARRANT FOR YOUR ARREST
I St. Paul Courthouse...................................................15 W. Kellogg Blvd........St. Paul .........55102.....(651)266-8180
❑ Ramsey County Law Enforcement Center................425 Grove St.................St. Pau1 .........55101 .....(651)266-9696
❑ Maplewood Branch ....................................................2050 White Bear Ave....Maplewood....55109.....(651)266-1999
DEFENSE ATTORNEY PHONE NO.
f�AT� Janua�y 29, 20'4 JUDGE: Handed to the defendant by PAA
Comments: DEFT REQUEST R8�R SHEET HANDED TO DEFT
i
Yage 1 of 1
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Saa�cL' F3a��n
REGISTER OF ACTIONS
Cnse:No.(2-VB-tJ-25g
State of Minnesota vs DEBORAH ANN BOWKER § Case Type: Crim/Tref Non-Mand
§ Date Filed: 01/30/2014
§ Location: Ramsey Criminal/Tra�clPetty
§ Downtown
§
PARTY 1NFORMATION
Lead Attomeys
Defendant BOWKER,DEBORAH ANN Female
2255 DELLRIDGE AVE DOB:06/12/1965
ST PAUL,MN 55119
Jurisdiction State of Minnesota
NONE
CHARCEINFORMATION
Charges:BOWKER,DEBORAH ANN Statute Level Date
1. Snow emergency parking restrictions 161.03 Petty Misdemeanor 12/18/2013
EVENTS&ORDERS OF THE COURT
nis►�osrrioNs
01/29I2014 Plea(Judicial Officer:Archer,Pete)
� 1.Snow emergency parking restrictions
Not guilty
06I16I2014 Disposition(Judicial Officer:Frisch,Jennifer L)
1.Snow emergency parking restriCtions
Dismissed
OTHER EVENTS AND IIEARINGS
0112912014 Hearing (8:00 AM)(Judiciai Officer Archer,Pete)
Resuit:Held
0113012014 Citation E-Filed
0113012014 Officer Notes
NIGHT PLOW.BEFORE PLOW.
01I3012014 Notice and Order to Appear
01/30/2014 Summoned-Own Recognizance
01l30/2014 Interim Condition for BOWKER,DEBORAH ANN
-Summoned
06/16/2014 Hearing (1:00 PM)(Judicial Officer Frisch,Jennifer L)
deltrequest
Result:Held
https://mpa.courts.state.mn.us/CaseDetail.aspx?CaseID=1616679915 7/11/2014
f
� CITATI4N � i'
State of Minnesota Ramsey District Court ;
City of �
Citation# IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII '
, 62�90�2Q376Q 620900203760 -- �
; DL Number State j
❑MN ❑CDL �
Name ;
First Middle Last
Address— Street, Apt# i
���Y State Zip ;
DOB(mm/dd/yyyy) Eyes Height Weight Sex Race Ethnicity ;
i
Vehicle.License No. Plate Year State Make Type Model Color
' �
Date of Offense;--. Time of Offense ❑AccidenUCrash �
�� '' � �' �� - ❑Property ❑Injury ❑Fatal ❑Pedestrian � t
Parking Meter Number Neighborhood Code ❑ Housing/Building Code �
�
❑Booked ❑ParWOperate ❑Owner ❑Passenger ❑Driver O
Offense Location T _µ�� - �,�=j �+ �
r o� N
NO 1 OfferlSe 'Statute/Ordinance ' 0
" � . '; ;� y
No 2 Offense Statute/Ordinance �
�
No 3 Offense Statute/Ordinance
❑Speed 169.14(subd ): mph zone ,
I
❑No Seat Belt Use 169.686.1(a) ❑No Proof of Insurance 169.791(2) �
AC Taken—AC: Test type: ❑ Refused ❑ Breath ❑ Blood ❑ Urine ;
❑Hazardous Material (DOT) ❑Unsafe Conditions O School Zone �
❑Entlangering Life & Property ❑Work Zone ❑Commercial Veh. DOT#
Identification: ❑DL ❑DVS Web ❑ Photo ID ❑Other
See back of citation for information on paying your fine. �
If cited for No Proof of Insurance or No Driver's License in Possession, Proof of Insurance and/or
Driver's License must be shown at one of the Violations Bureau locations listed on the back of this �
citation within 21 days from the date the citation is filed with the Court.
Please read the back of this citation carefully and respond.
i
I
i
Officer(s) Name(s)
Officer No(s). CN# Citing Depb� �"
How Issued ❑In Person ❑Mailed ❑Left at Scene
DEFENDANT
Saint Paul Police Impound Lot, 830 Barge Channel Road, Vehicle Release Form
Make: License #: 489KAD CN: 13267540 Invoice #: 23113
DatelTime Released: 1 2/1 8/201 3 06:14 Tow Charge: $ 123.95
Released to: TOTO Storage Charge: $ 0.00 (� �.�,�
Paid by: CREDIT CARD Admin Charge: $ 80.00 �/
1
Released by: KRISTIE Tax: (7.625%) $ 15.55 l
t
I,the undersigned,have recovered the vehicle described above. Subtotai: $ 219.50
I will check the vehicle for damage or any other problems that
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 problems to the Impound Lot staff Total Charges: $ 219.50
on this form prior to leaving 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 PROBLEMS/DAMAGE BEFORE LEAVING THE LOT
Signature 5iz000
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