Jermison Dunn, Laura NOTICE OF CLAIM FORM to the City of Saint Paul, Minnesota
Minnesota State Statute 466.05 states that °...every person...who claims damages from any municipaliry...shall cause to be presented to the
governing body of the municipaliry within 180 days after the alleged loss or injury is discovered u notice stating the time,place,and
circumstances thereof,and the amount of compensation or other relief demanded."
Please complete this form in its entirety by clearly typing 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 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 weel�s or longer depending on the
nature 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 DOCUMENTS TO: CITY CLERK,
15 WEST KELLOGG BLVD, 310 CITY HALL, SAINT PAUL, MN 55102
First Name L i n a+� Middle Initial Last Name���'L1SC5fl � Ul.�^��
Company or Business Name �� �S I(ltSS ���;
Are You an Insurance Company? Yes, N� If Yes, Claim Number? ��fi`�"
Street Address't'� a � k ��� �`5 �
�.�� Y ?��4
City cST• �Gt,U L State �l� Zip Code �5 l a � C���
Daytime Phone( ) - Cell Phone(�Z-�)�$� ��Evening Telephone( ) - �
Date of Accident/Injury or Date Discovered 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 o Samt Paul or its employees are involved and/or responsible for your damages.
c�st �n� yoc.�.-1 '� m (' n, � er is C-t� -5 ;., .
�Ql� V�� W CLJ Ovl � S �L' � � /vl.' '�i
�,j�e.�a.�.�-sa� . P t�,�c.�,s cv rn�:i si d�e `t�-Q�-�c u.ti rc.. �'-e-v�-ru�t t�e.6,��cs 'nrU�rl v �`s wc�c.�r�-t-
� c;r� �-d e c e� ha� a� �,e,n u�t-�- }-a 'a.Q Sc� wt-L� Z:.r�s
�.� w��=in � s h � h�cn�rat,s� `t�ic c.�,c�th � 31���
�, � s d nc� �r� h sh (� n
r-vtc� '�-,rc.le.,�-r> � h.�.cs hu:M1 t3�..c�ruJ�� t t.o �cm� �� s�au.Q p },� 1,�i�o "���•
lease check the box(es)that mo`s�closely represent the reason�or completing this form:
❑ My vehicle was damaged in an accident �My vehicle was damaged during 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 � U�ht�''� � � ��c�'
❑ Other type of injury—please specify
In order to process your claim vou need to include copies of all annlicable 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
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/or receipts for the repairs;detailed list of damaged items
O Injury claims: medical bills,receipts
O Photographs 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
R�C�i��.�
1UL �9 2���
July 29, 2014 '/
Ci•� ! Y \.r���af�.
This is a letter of more detail pertaining to the claim form submitted to the city of Saint Paul. My name Is
Linda Jemison- Dunn in reference to case#08100425 Commander Joshua Lego asked me to write a
letter to summarize the claim form I submitted on July 25. 2014. I started off speaking and calling the St.
Paul Police department speaking with commander Tim Lynch then commander Brian Coyle which I was
told they both are retired so I started talking with Police Officer Trish England who was one of the
officers on this case which now is Commander Trish England who ask me to fill out the claim form about
my husband vehicle that was auction on July 3, 2008 this was a homicide case he was killed and this
vehicle was not even to be released I was told that the vehicle was on hold until the trial was over we
did not go to trial till two years later the vehicle was released on June 5, 2008 my husband was killed on
May 31, 2008. Commander England told me that the vehicle should not been released but there were
several vehicles that were on hold during this investigation this was not to happen. I was not notified
because my understanding that my vehicle was being held for evidence for the trial. Commander Joshua
is looking in the property room and documentation to try finding my husband things that he had on him
when he was shot which happen to disappear. I was told that the only things that they have of his is his
cloths that he was shot in, I am very upset and confused how this could of happen! I pray and hope that
the city can and will compensate me for my loss and i fill that the city is responsible for my losses
Commander Joshua and Commander Trish both have said they support me with this claim and
Commander Joshua said he has email your team about this matter. I will wait to hear from someone
with a decision. Thank you for reading my letter and if you have any further questions please feel free
to contact me at (321) 355-8022.
Sincerely,
�,� _� r i
�� _ y rr si�
Mrs. Linda Jemison-Dunn
Failure to complete and return both pages will result in delay in the handling of your claim.
All Claims-please comnlete 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 Un own (circle)
If yes,what department or agency? Case#or report# �g �0 C5�ZS
Where did the accident or injury take place? Provide street address,cross street,intersection, name of�p k or facility,
closest landmark,etc. Please be as detailed as possible. If necessary,attach a diagram. �� �"��`�-�' ��
I Y1 t�
Please indicate the amount you are seeking in compensation or what you would like the City to do to resolve this cl '
toyou�satisfaction. c�- L-Q,��. um � S s�'�an�1 c �e-�i+�'L
CR.r� hi s v�+.�
Vehicle Claims- lease com lete this section ❑check box if this section does not a 1
Your Vehicle: Year Make V Model
License Plate Number ��,3 State �' Color`
Registered Owner �� -�`��
Driver of Vehicle �' ' ��n �L��
Area Damaged (t,�[nc�-c-� � �t ICin.r�-��� t�l-' h�3 h-�er� 5 u�'n'r�'
City Vehicle: Year Make Model
License Plate Number State Color
Driver of Vehicle(City Employee's Name)
Area Damaged
Iniurv Claims please com�lete this section �check box if this section does not avnlv
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 fornz,you are stating that all information you have provided is true 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 Z�l°�"���
Print the Name of the Person who Completed this orm: � ��� m �S� � dJ�N/�
�-----'N., � �� iz rL
Signature of Person Making the Clairrt: �_--�
Revised February 2011