Faraci .�`'�.E�...
NOTICE OF CLAIM FORM to the City of Saint Paul, Mi�,�sota��;,�93
Minnesota State Statute 466.05 states that "...every person...who claims damages from any municipaliry...shall cause�a�pre�I¢t�d��e
governing body of the municipaliry within 180 days nfter the alleged loss or injury is discovered a notice stating the f:me,plc7ce,and`'y
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 weeks 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
hk �`�' �_- �
First Name �,lt�n.'AT+{-A�i' Middle Initial�Last Name l��f��� �' `-" ° " ��-'
Company or Business Name ��V1'��i�`� ��'�`',.irJ�'�'f2//�L. ��• ,��,I � � �(�1,�j
Are You an Insurance Company? Yes No� If Yes,Claim Number? �-�e-�•�.�:-�p ��.��:;
Street Address ��C'O LC Nr/Z� i�G�/��� �'.UiC'1/-- , 57 f- c���
City )'��!'11�oT�-� t-��'1 ��1�� State {�'1 i� Zip Code �Jlc3-�i
�xr���-
Daytime Phone (,��- a-1� Cell Phone(�)�-7(�'/7 Evening Telephone( ) -
Date of Accidend Injury or Date Discovered ��-�a-��' � � Time O: O 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 Saint Paul or its employees are involved and/or responsible for your damages. W� `� ���i�
I,�PrS T������ ��`� �c'C��V S� ��?�� ,✓ 7.�C?En�.S�=' ;�i�..i�T�` i-�rl rb
rX�i�ck� ��E �7f�"fic'.r�'1`/Ur�
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
❑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
❑ Other type of injury-please specify
In order to process your claim vou need to include copies of all auplicable 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 WII.L 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
�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
Failure to complete and return both pages will result in delay in the handling of your claim.
All Claims-ulease comnlete this section
Were there witnesses to the incident? Yes '� No Unknown (circle)
Provide their names, addresses and telephone numbers: U''��C�'�' '��C� . �.0��-Yl'��S
H-EFs� V�'� C r�-i� `7'c���-��- c?��C�(Z . 7�ozl�I c�
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 you are seeking in compensatiQn oriw at you wo}�ld like the City to do to resolve thi c�la� �'�}
to your satisfaction. � 1'�y-•�!o � t,cX�c.��cl �1�� l�'�Y ��lrif� ���L�� �A�C'.�,
Vehicle Claims- lease com lete this section �check box if this section does not a 1
Your Vehicle: Year 0 Make Model �
License Plate Number pZ � State�j�Color � /
Registered Owner ��J: D �e� �r�vlN�/� � �
Driver of Vehicle -.�o f�►J 2 � �
Area Damaged �c^�%'�
City Vehicle: Year Make Model
License Plate Number State Color
Driver of Vehicle(City Employee's Name)
Area Damaged
In'ur Claims- lease com lete this section 6d check box if this section does not a 1
How were you injured? , A
What part(s)of your body were injured? 1J � l� �
Have you sought medical treatment? Yes No Planning to Seek Treatment(circle)
When did you receive treatment? ti� � (provide date(s))
Name of Medical Provider(s): 1� � �
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 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 //�7 /r3
Print the Name of the Person who Completed this Form: �..5 o N�7'I-k�rJ �� l�r��2tt�C I ��bY'iL`�
Signature of Person Making the Claim:
Revised February 2011
LAKE & LAND SURVEYING, INC.
dba Development Engineering,P.A.
Land Surveying,Civil and Geotechnical Engineering,Materials Testing,Construction Management
1200 CENTRE POINTE CURVE,STE 275,MENDOTA HEIGHTS,MN 55120
PHONE:651-776-6211 EXT 222/FAX:651-776-6711
JFDEVENGPA@QWESTNET
January 9, 2013
City of Saint Paul
City Clerk
15 West Kellogg Blvd
310 City Hall
Saint Paul, MN 55102
RE: Claim Form
Dear City Clerk:
On December 24, 2012, Christmas Eve, the City of St Paul's Surveyor, Mr. Sam Gibson, said he was
working. I thought I would come in and see Mr. Gibson about a job I was working on because I could probably
easily find a parking spot. My hunch was right, I found a parking spot across the Street form the St Paul Annex.
I went up to pay the new meter box. A woman was standing at the meter box trying to get her parking receipt.
She turns around and throws up her hands up in the air with discuss and says the parking meter machine does
not work. I approach the parking meter machine and input my number and hit the#key. The meter spits out a
ticket, enclose, with a 23 minutes of time (Oh my lucky day). I am thinking I would like to have more time on
my meter as to not get a traffic ticket but there are no instructions on how to do this. If the old meters had time
on them all you had to do was insert additional coins and get additional time. I did not know what to do, so I
thought well maybe my meeting with Mr. Gibson would be short.
After my meeting with Mr. Gibson I went to get my truck. It was missing! I thought it had been stolen.
I walk over to the Ramsey County Police, located in the St Paul Annex Building, and the clerk gave me a
number to call the Saint Paul Police. I call the Saint Paul Police and they said my truck had been towed to the
Saint Paul Impoundment Lot and they gave me the phone number of the City of Saint Paul's Impoundment Lot.
I called the Impoundment Lot and the clerk said that I needed to get Motor Vehicle Registration Tabs for my
truck before I could get my truck out of the Impoundment Lot. I thought"oh great it is Christmas Eve"and I
wonder if the Driver&Vehicle Services office is opened. I called my wife, whom came to my rescue, and she
picked me up. I went over to the Driver&Vehicle Services office located in the basement of South Saint
Paul's City Hall,they where open"halleluiah"and paid for my new license plate tabs. I then went over to the
Impoundment Lot and paid$144.76 to get my truck out of the Impoundment Lot. The Police Officer Clerk
handed me a ticket for parking at meter without payment of ineter fee beyond the time permitted by meter and
expired registration. I asked the Police Officer Clerk why they had towed my truck. The Police Officer Clerk
said it was because of my expired registration. I told the Police Officer Clerk that I must not have gotten the
notice from the Minnesota Department of Transportation because we had moved our Company Offices and that
the Post Office does not always forward the mail as requested, and I just did not think to look for expired
registration. The Police Officer Clerk had me install the new registration tabs on the truck's license plates prior
to letting me drive out of the Impoundment Lot.
1
LAKE & LAND SURVEYING, INC.
dba Development Engineering,P.A.
Land Surveying,Civil and Geotechnical Engineering,Materials Testing,Construction Management
1200 CENTRE POINTE CURVE,STE 275,MENDOTA HEIGHTS,MN 55120
PHONE:651-776-6211 EXT 222/FAX:651-776-6711
JFDEVENGPA@QWEST.NET
The ticket says if I pay the fee of$110.00 for expired registration/expired tab and send it in then"Payment of a
fine in any amount is a plea of guilty".
Well I thought, I should lookup the state statute on the Worid Wide Web and see for myself what the Minnesota
State Law says.
Minnesota Statues 168.09 Registration; Registrations, Subdivision 5,Defenses to failure to renew.No
person may be charged with violating this section by reason of failure to renew the registration of a previous
registered motor vehicle, except those vehicles registered under section 168.187, if: (2) the person renews the
registration and pays the motor vehicle tax and fees due within ten days of cited for violation. Please see
enclosed copy of this statue.
Please see the enclosed copy of my ticket dated December 24, 2012,pictures of my truck with the new
registration tabs, the receipt from the Driver&Vehicle Services office with time and dated December 24, 2012,
and the receipt of the Saint Paul Police Impoundment Lot with time and dated December 24, 2012.
As you can see by the receipts date of December 24, 2012, I have paid my motor vehicle ta�� and fees within the
10 days of being charged with a violation. Therefore, I am not in violation of any vehicle registration law.
I made a mistake of not looking to see that my vehicle registration had expired. The City of Saint Paul's Police
could have just written a warning ticket stating a person must renew the registration and pays the motor vehicle
tax and fees due within ten days of cited for violation or be subject to a fine. I would have renewed the
registration and paid the motor vehicle t� and fees due within ten days of cited for violation.
The City of Saint Paul Police's wrote a ticket that wanted $110.00, knowing that I may not be in violation of the
vehicle registration law. The City of Saint Paul subjected me to great arixiety by towing my truck away. The
City of Saint Paul subjects me to a lot of wasted time getting my truck back and disputing this ticket and
impoundment fee.
I respectfully request that you refund me the $144.76, I gave the City of Saint Paul's Impoundment Lot. I also
respectfully request that you fix your parking meters with better instructions.
Sincerely,
_ _P _���..
Jonathan L. Faraci, President
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� � �'f Minnesota Motor Vehicle Registration /Cak �2s sR�,,vE No�<��
r ,���� &� $OUTN SA651-557L?603' Jj��S �m
!�
W@�11C�B S@f'V�C@S Merchant ID: 8p19347981
Term ID: 0911340008019347981F�01
A�� Keep this Registration/C� ,
DEVELOPMENT ENG PA _ 'S�le
ST PAUL, 55 06 D DEC 1 4 �� Minnesota Law(MS 16� zzzzzzzzzzzz11Z9
of insurance be in the ve hpgT�p�p Entry �ethod: �uiPed
DEPI�Ty#35 shown to a peace office
New Plate sticker Total; $ 151,60
Nsa3sss2 CAB CARD. If your vehi
Plate no. Expira6on gross weight of the vehi 1�����1� ?2:�9;39
702CXK JUN30,�s card in the vehicle at all Inv��� ��4�� ApPr Code� 9��72P
Vehicle ID No. Make Year ' �PAt'vd: �h1111E
1 FTYR10D89PA441 S:, FORD 2009 You can contact DVS i .
TiBe Na Gross Weight or Base Value c�5to��E�- c�
Phone: 651-297-21:
_K2860Y923 16555 7twr�K vo�
Reg Tax 144.0o TTY/TTD: 651-282-i
Contribution 0.00 motor.vehicles@sta__......
Plate Fee O.00 Ser�l��c�d assuer ac�ordine
wnee�Tax o.00 I attest by this transaction tha to tn� .:+ terms,
Technology Surcharge �.00 insured while operated upon t t°thElr Pay�� �
Filing Fee 6.00 r�5to����'r°PY
Total Due 151.00 required by law. Proof of insur
in the vehicle. THaNK vou�
https://esupport.mndriveinfo.org/dvsinfo/VH43/regcard4.asp?Code=43 12/24/2012
pound Lot, 830 Barge Channel Road, Vehicle Release Form
ST PRUL �
SAINTePAUL�IIN.F�55107R2qsg License#: 702CXK CN: 12300571 Invoice#: 142067
651-266-5642
���hiot�i7�a�ee6ase�a4e� /24/2012 13:00 Tow Charge: $ 54.50
Sale Storage Charge: $ 0.00
zzzzzzzzzz�cZ179
�,STERC�iD Entrv M�thod: �iaed � Admin Charge: $ 80.00
1ota1: S 144,Zfi Tax: (7.625%> $ 10.26
12i24i12 13:04:59
Inv �; �Q ��p�; 15� recovered the vehicle described above. Subtotal: $ 144.76
�PPrud: Online or damage or any other problems that
le this vehicle was in the custody of the Service Charge: $ 0.00
Custoner copY - �tment. I acknowledge I will report
THf�IK YOU! er probiems to the Impound Lot staff Total Charges: $ 144.76
_ _ _ , ving 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 BEFCRE LEAVING THE LOT
Signature 5iz000
_ _ ,.,�e Impound Lot, 830 Barge Channel Road, Vehicle Release Form
-�Vfake: 09 FORD License#: 702CXK CN: 12300571 Invoice#: 142067
Date/Time Released: 12/24/2012 13:00 Tow Charge: $ 54.50
Released to: TOTO Storage Charge: $ 0.00
Paid by: CREDIT CARD Admin Charge: $ 80.00
Released by: CHERI Tax: (7.625%) $ 10.26
I,the undersigned,have recovered the vehicle described above. Subtotal: $ 144.76
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. t acknowledge I will report
damage and/or any other problems to the Impound Lot staff Total Charges: $ 144.76
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 BEFCRE LEAVING THE LOT
Signature si2000
welco►ne fo St. Paul
� S�AC� 6397
� EXPlRES
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168.09,2011 Minnesota Statutes Page 1 of 2
��
2011 Minnesota Statutes
168.09 REGISTR�4T�ON; REREGISTRATION.
Subdivision 1.Registration required.No trailer or motor vehicle, except as is exempted by section
168Al2, may be used c�r operated upon the public streets or high���ays of the state in any calendar year until
it is registered as provided in this section,the motor vehicle tax and fees as provided in this chapter are paid,
and the number plates issued for the trailer or motor vehicle are displayed on it.No trailer or motor vehicle,
except as provided by section 168.012, v��llich for any reason is not subject to taxa#ion as provided in this
chapter, may be used or operated upon the public streets or highways of this state until it is registered as
provided in this section and displays number plates as required by this chapter, eYCept that the purchaser of a
new trailer or motor vehicle may operate it without plates if the permit authorized by section 168.091 or
168.092 is displayed.
Subd. 2.Reregistration. When a motor vehicle registered in Minnesota,has during the calendar year for
which it is so registered, been reregistered for the following year,the display on such motor vehicle of the
plates issued for such motor vehicle on its reregistration for the foilowing year shall on and after November
I S of the calendar year in which it was so reregistered coi�stitute compliance with subdivision 1 requiring
display of plates except as provided in subdivisions 3 and �.
Subd. 3.Proratable vehicles; other vehicles.(a) Plates or other insignia issued for a motor vehicle
registered under section 168.187 for a calendar year shall be displayed on the motor vehicle not later than
12:01 a.m. an March 2 of the year unless eYtended by the registrar for the period of time required for the
issuance of the new plates or insignia.The registratian year for vehicles registered under section 168.187, as
provided in this section, is from March 1 to the last day of February for 199� and succeeding years.
(b)Except for a motor vehicle registered under section 168.017 or 168.187, plates or other insignia
issued for a self-propelled motor vehicle registered for over 27,000 pounds shall be displayed on the vehicle
not later than 12:01 a.m. on March 2 of the year,and, e�cept for recreational equipment, not earlier than
12:01 a.m. on February 15 of the year, unless otherwise extended by the registrar for the period of time
required for issuing the new plates or insignia.
(c)Except for a motor vehicle registered under section 168.017 or 168.187,plates or other insignia
issued for a self-propell�d vehicle registered for 27,000 pounds or less and all other motor vehicles shall be
displayed not later than 12:01 a.m. on March 2 of the year, and, eYCept for recreational equipment, not earlier
than January 1 of the year unless otherwise extended by the registrar for the period of time required for
issuing the new plates or insignia. The registration year for all vehicles as provided in this paragraph and �
paragraph (b) is from March 1 to the last day of February for 1979 and succeeding years. '
Subd. 4.Display.A vehicle registered under the monthly series system of registration shalJ display the �
plates and insignia issued within ten days of the first day of the month which commences the registration �
periad.
�.�-� Subd. 5.Defenses to failure to renew.No person may be charged with violating this section by reason of
failure to rene�v the registration of a previously registered motor vehicle, except those vehicles registered
under section 168.187, if:
(1)the person praduces a statem.ent from the registrar to the effect that the person was not notified by
the registrar of the armual renewal for the reg.istration of the vehicle to which a citation was issued; and
� —� (2)the person renews the registration and pays the motor vehicle tax and fees due within ten days of
being ci.ted for the violation.
Subd. 6. Semitrailer.For a semitrailer, as defined in section 168.002, subdivision 30, a number plate
must be assigned to the registered owner as identification for the vehicle.This number plate must not display
a year designator. The registration card must indicate the number plate for the number plate to be valid.
https://www.revisor.mn.gov/statutes/?id=168.09&year=2011 12/26/2012
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