Tuzzolino, Lisa � f�i_��� �I��
� . JUL 2 2 20i4
NOTICE OF C�..A,� FORM to the City of Sa�x�t Paul, Minneso���� �L��K
Mrnncsola Stulr Slatute 4GG.OS.�rare.s that"...rvery persan...who claims ria»uiges jrom any municipality...,rhalt caus�tu be pr�senfed m die
governing 6oriy of the►nuntclprxdity wilkin It30 d�eys after the alleged lorr or injeiry is discovered a rrnrice.statinR tht tlme,,�fQre,and
r�•ree�mslance�lhereof,uRC1 rhe amnunt of cumpensutian or oflie.r retief�icmanded."
PleeHe cr>mplete this form in�ts eniirety by clearly typing or.ptfating your answcr to cach qucstion. If more spacc is
nccded,attac}►additioasil shccts. �'1�:nulx that you w71 not be cantacted by telephone to clarify answers,so provide as
much in�onmut�on as ncccssary ta explain your claim,and the amacnt ot compcnsation bcing requested. Yau wilt recelve�
wnitten acknowledgement once your form fs recefved. Thz process can t�kc up to tcn wecks or tongcr depcnding on thc
nature of yuur claim. This form must be sianeda and hoth pages compicted. If somcthing da�s not�pplq,writc°N/A'.
SEND COMPLETED FORM AND OTHER AOCUN�N'TS TO: CX�"X' CLERK,
�5 WEST KEX.,LdGG BLVD,310 CITY HALL, SAINT PAUL, MN 55102
Firs[Name ��-- Middle initial � Last Na,me ��.?D�l �1�
Comnary er T3t�siness Nan•e_ d'�. _� _____ _�� _.
Are You an Insuzanee Compuay? XES/ o if Yes,Cl�.im Nuxc�ber?
Streec Address lll � � �l � `� � r�s
Cily V��i .1�'�'�l�l Slt�te Q✓ Zip Ccxle S Sd `�
Daytime Phone(� - Cell Phone(�-j���Z vening Telephone(_� -
Date c�f A�cident/Ynjury vr bxte niscoverc;d „ ._....._.__. Timc; arr�/pm
Please state,in detail,what occurred(happened),tind why you are submitling a ctaizrt. Pleatse indicate why or ow you
eel l e �ly uf Sain��'aul or i s em loyees are' vCr vzd a d/or r nsible for,ygur dfun es. f a .
yT
�
• ,
Plcase check the box(es)that most closely represent the reason fer complEting this farm�
❑My vehicle was dfunaged in an accident ❑N�y v�hicle was damaged during a tow
❑My vehicle was damaged by a pothole or, condition of�he street ❑My velticle was damaged by a plow
�ty vehicle was wrongfull tr�ow_ed tutd/or ticketed � ❑I was injured on Ci[y property
�7 Other type of nreperCy dannage—please specify
❑Other type of injury—please speci�y
ln arder to process�our claim vou need to include cooies of all aaa�icable documents.
For the elaims ty�;s listed below,ptease be sure to include the docum�ez�t3 xndieaced or i�will delay the handling of
your claim. Docaments WILL 1�OT b�relurned anil he.`cnmc lhe proper[y of[he Cicy. You are encouraged Co kECp a
cupy for yourself before submitking your claim form.
O prvpc�ly damage clainis to a vehicle:two estimates for the repttirs lo your vehiC.fe if Ihe damage exceeds
$5�0,00;or ct�e actual bills andfor reeeipts for the repair� ,
d Towing claims:legible copies of any tick�t issued and a copy of the impound lol r�ctipt
�Other praperty damage claims:twp repair estimates if the damage exceeds$500.00;or the actual bills
and/or receipts for the repairs;dett�il�d list of damaged items
O Injury claims'medical bills,receipts
Q�horographs are always welcome to docum�nt and suppnrt you�claim bat wii]not be retumed.
page X of 2—Please complete and returo bath pages of Claim Fortt�
�ailure to complete and return both pages will result in delay in the handling 4f your ciaim.
All Claims—olease comolete this section �—'�-,
Were rhere wicnesses to the xncident? Yes No� Unknowc� (circl�)
Provide their�ames,ad�dr��ses and telephone numbers:
.w `�-�'
Were the police or law enforcement called7 Ye,q N'o ��own� (circle)
If yes,what department or agency7 Case#or report#
Where did the aceident or injury take place? Provide street address,cross street,intersection,nazne of p k or facility,
ciosest l ark ete. Pl�be as� "led as possible. If necessary,a[tach a diagram_Sp�� �a5.¢ f-�l.e--� �
__�-�� � �:� � _
�. - -
Please indicate the amount you are seeking in com nsation or what you would]ike the City to do to re�colve this claim
to your sausfacuon. �' �� �� ��
Vehicle C'�aimis—please co�plete this sect�on �check box i�this�ectian daes noc avolv
Your Vehicle: Year�LrJf)C� Make vl Model
License Plate Number G S�D Statel�� olor
Registered Owner
Dtiver oC Vchicle �--
Area Damaged
Ciey Vehicle: Year Mnlce Model �
License Plate Number 3tate Color
Driver of Vehicle(City Empl�yee's Name) .._........... ._.—
Area Damaged
lniurv Ctainas p�ease eomulete this secti�n �(check box if chis secdon does ao�annlv
How were yau injured? — �
What pun(s)of your body w�re injured?
Have you sought medical vea[menc? Yes No Planning to Seck Treatment(circte)
When did you receive treaunenc? (provide d�te(s))
Name of Medical Provider(3):
Address Telephone
Did you miss work t�,s a resulc of your injury? Yes Nu
When did you miss work7 (provide date(s))
Name of your Employer:
Address Tcicphoue
Check here if you are attaclt�ng ntno�re pages to this claim form. Nu�uber of additional pages�.. _
� �
By sigRing this form,you are stating that all infornaalion you have provided is true and correct to the best
of your knowledge. Unsigreed forms will not be processed.
,��bmi,tting a faLse claim cacr�result in prosecution. Uate form was completed
�� /
Print the Name af the Y'erson who Completed thi orm: � � U` � _Y)�
5ignature ef Person Making the Claim:
Revised Febtuary 2011 �
Page 1 of 1
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REGISTER OF ACTIONS
C4sE No.62-VB-14-281
State of Minnesota vs LISA MARIE TU2ZOLINO § Case Type: Crim/Traf Non-Mand
§ Date Filed: 0113112014
§ Location: Ramsey Criminal/Tratfic/Petty
§ Downtown
§
PARTY INFORMATION
Lead Attomeys
Defendant TUZZOLINO,LISA MARIE
657 CASE AVENUE#1 DOB:08/11/1980
ST PAUL,MN 55106 �(�i�_, /
��
Jurisdiction State of Minnesota ���5�
NONE
CHARGEINFORMATION
Charges:TUZZOLINO,LISA MARIE Statute Level Date
1. Snow emergency parkirg restrictions '69.Q3 Petty Misdemeanor 12/25/20�
EVENTS&ORDERS OF THE COURT
D[SPOSITIONS
01/31/2014 Plea(Judicial Officer:Archer,Pete)
1.Snow emergency parking restrictions
Not guilty
06I30/2014 Disposition(Judicial Officer:Bryan,Jeffrey M.,)
1.Snow emergency parking restrictions
Dismissed
OTHER EVENTS AND HEARINGS
Ot/31/2014 Citation E•Filed
01131/2014 Office�Notes
N(GHT PLOW,'PLOWED IN
01/31/2014 Notice and Order to Appear
01/31/2014 Summoned-Own Recognizance
01/31/2014 Interim Conditio�for TUZZOLINO,LISA MARIE
-Summoned
01131/2014 Hearing (8:15AM)(Judicial OfficerArcher,Pete)
Result:Held
06/30/2014 Hearing (1:00 PM)(Judicial Officer Bryan,Jeffrey M.,)
deft request
Result:Held
https://mpa.courts.state.mn.us/CaseDetail.aspx?CaseID=1616682369 6/30/2014
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