Aubin, Michael REC�I�IED
JUL 2 � 2014
NOTIC� OF CLAIM Fo►RM to the City of Saint Paul, Min���LERK
Mi�uieso�a State Sta�ute 466.05 states tlrcu "...everv persrnt...who c/ainrs dnrna�esJrrnn anv r�tunicrpalitv...shal/cnusn 10 l�e��resc:ntec!tu the
�oi�erning bodv uJ'd�e meuticipality mithi�i /80 d�n�s after dre nllehed loss or injurv is discovered a i�olrce statiiig tl�e�ime,pluce,cuul
circwn.�7ances t{rereof,nnd tlre cimount nf compensntinn or uther relief denrnnded."
Please complete this form in its entirety by clearly typing or printinb your answer to each question. If more space is
needed,attach additional sheets. Please note that you will not Ue 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 witl receive a
written acknowledgement once your form is received. The process can take up to ten weeks or longer depending on the
nature of your claim. This form must be signed,and both p�ges 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 �� I�G h a P� Middle Initial S Last N1me /-1 t�t bi✓1
Company or Business Name l�f}
Are You an Insurance Company? Yes/� 1f Yes, Claim Number?
Street Address �>�� �I 10 �rq� � 58�+�'1
City��a�l��a J� State rn � Zip Code S8
Daytime Phone ( .�( )�,�-7�7� Cell Phone ( ) - Evening Telephone (�-�'�)��- 7�73
Date of Accident/lnjury or Date Discovered D2C - i�S � 2 � �.3 Time �U�•a2� am�
Please state, in detail, what occurred (happened), and why you are submitting a claim. Please indicate why or how you
feel the C�ty of Saint Paul or its employees are involved and/or responsible for your damages. C I �A'�10�
' ci q�-lern 21 Ot - � a
`� . r o� 1 -
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 durinb a tow
❑ My 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
O Ocher type of injury—please specify
In order to process your claim you need to include copies of all applicable 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 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 the actual bills and/or receipts for the repairs
� 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/or receipts for the repairs; detailed list of damaged items
O Injury claims: medical bills,receipts
O Phorographs 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 pages will result in delay in the handling of your claim.
All Claims—please comple�te this section
Were there witnesses to the incident? Yes No Unknown (circle)
Provide their names, addresses and telephone numbers:
Were the police or law enforcement called? Yes No Unknown (circle)
If yes, what department or agency? Case#or report#
Where did the accident or injury take place? Provide street address, cross street, intersection, name of park or facility,
closest landmark, etc. Please be as detailed as possible. If necessary, attach a diagram. � _ _
Please indicate the amount ou are seeking in compensation or what you would like the City to do to resolve this claim
to your satisfaction. I -S� • G� A �O� WA Cl� 1'hISSe �-} °�orrie
�' wo�lc� (' k` re i m►x, � 1� -FoW o o?I -�D .
Vehicle Claims—�lease com�lete this section ❑ check box if this section does not anniv
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
In�ury Claims—please com�lete this section �check box if this section does not tlpplY
How were you injured`?
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
By signing this form,you are stating tlaat all information yozc have provided is trtce and correct to the best
of your knowledge. Unsigned forms will not be processed.
Submitting a false claim can result in prosecution. Date form was completed ���y Z� aO f�
Print the Name of the Person who Completed this Form: I � 1 Ic�a�.� �ubi✓�
Signature of Person Making the Claim:
����� �
Revised February 201 I
Saint Paul Police Impound Lot, 830 Barge Channel Road, Vehicle Release Form
Make: 11 CHRYSLAR License#.�7SaGDG CN: 13267540 Invoice#: 23614
Date/Time Released: 12/18/2013 22:53 Tow Charge: $ 123.95
Released to: TOTO Storage Charge: $ 0.00 �
' `� • � )
Paid by: CREDIT CARD Admin Charge: $ 80.00 � % ' �\:'"
4— .
Released by: HEATHER Tax: (7.625%) $ 15.55 ;+
i ,�
I,the undersigned,have recovered the vehicle described above. Subtotal: $ 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
5/2000
Signature
,..
Page 1 of 1
5kip?e Nta,n Cen:en±L.eqout My Account Sezarch r;tenu Ne�v G imir:ai.'(raffic;l"et:V��earcn Retine L;��:ahon r;f tviNC�S Sites Case Search Images 11t1p
Sa�a;ci� Bac�
REGISTER OF ACTIONS
C.�sF::�o.62-V l�-t d-2(1�1
State of Minnesota vs MICHAEL JOE AUBIN § Case Type: Crim/Traf Non-Mand
§ Date Filed: 01/28/2014
§ Location: Ramsey Criminal/Tra�c/Petty
§ Downtown
§
NAR7'Y INFORMATION
Lead Attorneys
Defendant AUBIN,MICHAEL JOE
8394 HILO TRAIL SO DOB:04/03/1960
COTTAGE GROVE,MN 55016
Jurisdiction State of Minnesota
NONE
CHARCEINFORMATION
Charges:AUBIN,MICHAEL JOE Statute Level Date
1. Snow emergency parking restrictions 161.03 Petty Misdemeanor 12I18/2013
EVEN"fS&ORDERS OF 7'IIE COURT
DISPOSITIONS
01/2112014 Plea(Judicial Officer:Xiong,Neng,)
1.Snow emergency parking restrictions
Not guilty
07/21/2014 Disposition(Judicial Officer:Yanish,Jo Anne M.)
1.Snow emergency parking restrictions
Dismissed
OTHER EVENTS AND HEARINGS
01121/2014 Hearing (8:03 AM)(Judicial Officer Xiong,Neng,)
Result:Held
01/21/2014 Notice and Order to A�pear(Judicial Officer:Xiong,Neng,)
01/28/2014 Citation,_E.-Filecl,
01128/2014 Officer Notes
DAY PLOW
01128l2014 Summoned-Own Recognizance
01/28/2014 Interim Condition for AUBIN,MICHAEL JOE
-Summoned
07/21/2014 Hearing (1:00 PM)(Judicial Officer Yanish,Jo Anne M.)
ConveRed from Vibes;Delt requested court date;De(t declined to plead guilty and have�ine suspended;R&R sheet provided to delt
Result:Held
https://mpa.courts.state.mn.us/CaseDetail.aspx?CaseID=1616676614 7/21/2014
� _
CITATION
State of Minnesota Ramsey District Court
Cit�r of
Citation# s �����ryIU�I:lI��1�1���1U1�11�111�111�1111
62Q90Q�7233rj 620900172335
DL Number State
❑MN ❑CDL
Name
Frst Middle Last
Address—Street,Apt#
City State Zip
:DOB(mm/dd/yyyy) Eyes Height . Weight Sex Race , Ethnicity
Vehicle License No. Plat Year State Make Type. Nbdel Color
�. .fj �. � �� f , ' ,'4 <. � f
. : ,_, .. . ......,,
Date of Offense , Tir�e of Offe e ❑AccidenUCrash .
— { .' �. � ❑Proparty ❑Irqury ❑Fatal ❑Pedestrian
Parking Meter Number Neighborhood Code ❑ HousinglBuilding Code ` N
�
❑Booked Gp Park/Operate ❑Owner ❑Passenger ❑Driver O
Offense Location , Q
� �° -� �', ; . � ;��' ? �1
No 1 Offense statute/ominance? _ �
- " , , _ ..- W
� No 2 Offense _ sr�n��o�d��e� �
C�'1
No 3 Offense �����"�
❑Speed 169.14(subd ): mph zone
❑No Seat Belt Use 169.686.1(a) ❑No Proof of Insurance 169.791(2)
AC Taken—AC: Test type: ❑ Refused ❑ Breath ❑ Blood ❑ Unne
�Hazardous Material (D0� ❑Unsafe Conditions ❑School Zone
❑Endangering L'rfe& Property ❑Work Zone ❑Commercial Veh. DOT#
IdenUfication: ❑DL ❑DVS Web ❑Photo ID ❑Other
See back of citation for information on paying your flne.
If cited for No Proof of insurance or No Driver's License in Possession, Proof of Insurance ancUor
Driver's ticense must be shown at one of the�olations 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.
Officer(s)Name(s)
Oifice�No(s). ,' ,�;� . CN## ._ Citing Dept
HovV�ssued ❑In Person ❑Nfailed O Left at Scene
DEFENDANT =�
:.- ., : ;<: ...�. . , .., r::, , � ...,;H> � _ _,:,, -