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Doucette, Sharon
RECEIVED t'.AR 06 2€!23 NOTICE OF Cl,AIM FORM to tlie City of Saint Paul, Minnesota CITY CL ERK -r uhni ybif.Jtrmvdvd r'lrav uvulilrlo ihli Is'ns Ill IIs tllllnlY bi tlnuh IvpJ nr prlatJ ieor iinmiiii lo ixh ipirillm IT yon )me aldllmsl dneum+rniiiiiiiii YOU may ald ihiia* dotumi iili tn vnui iulimluka 'i'rm s 11111111 b+ rimrari*d by li& Iilima iml k tarl rkJibn It 51PllNI Th+ tfalm p Tar is i nt%Jloai ciio lake iip'iardi of (oiir 141 flHuxkl:, : h2"6ri"lkl"7:m) uiir"n"vi'l":in;Iaiiti"n"i If%dl%@Illllbn;Inl;%l:l:allhlPs:mlllll7%lu:71lpvm( t,dr: g,llfflllffi,t.;11;l.liilhll#ll!I,%I Uhllp"l=lll. ,Jl,l,Ill,,i,uT -%,%, .aliilul)zms7 ,,-. liidn iJualq I iril S lian+ii I-'isl S.iini: I)oubelli: l'leati: Indti.tlc '} tlllr l'riinoiinh Sltc I Ici 11m I Ic I lini IIIQ 11icv 11ieiii{l liein Conipain or Ilusmi:sq Nnma Is Iliis claini lieiiig iiiiick h) an Insur.uice Cnmpaiiy" Nl) II !I <. l%l1Jl p' vour ( lanii I ilc Niuulier? k 1111% ilaiin licnig marlc h> ;ui.litotiici." O If vcs. 1111111 IS i<oiir Filii Nuiiihcr? II sch. tlicii PTOl iilc voiii Inqiircd's (licnt's haiiic Sirsct.lddrcss 89661asniinc lane S Cili Cottage [iruve Stale 'ilN Xili UuJc 55016 Daimnc ll'ork Pliim: 651-216-2555 Cdl l'lii+ne 65 12 16:'555 Dale o( IncuJcnl or Dale Discoicrcd (Slusl coinplelc) 3 2 2021 l'nnc 8 45 I'S{ Plcasc state m dciail iih.it liappcncrl Ilial prompicil )ou to file a Notice orClann l'onn &ly i'eluslc siiuck alarge di:cp potliolc on L Ogle} .Vloii Roarl in Ilic easlboiind laiic Tlgi11 hslorc tlis pt11nl Dougliis RJ Please Shlle Silly Or 11011 %Oll Icel Ilic (if> of Saint Palll IS is<lxinsibk: lot 'iOUl I)amriges" 11118 palcular Tit)111011! haS Ileell Ilii:ic lot a lung 11mt: aliJ li.is groun Over 111.11 Illnc; Jl k..bl oiie mOllll1 pllO} 10 111€ ll1Cltklll lli: liiivc scsii Imllllple C(IT'l 1111 Il1.il poTholc allJ glOp to clicc& tlisir s cliiJe. m snine init.nicaq hai e to gat tliair car tou cil }'lcihe clicck ilie it'iisiiii iliiil nllliil cliiscl) di'sci'ihcs tlic i'c<uiiii l'iii' !lllllr hiiliinittiiig a cliiiiii. Pleasc notc tlie Joctiniciits tliat uill necd to lx: proiiJcd u itli )our i:nnipkli:J f'onn liliotogriiplis dl bc.ii:ciipteJ .'lll Jocumcnts sulmiillcJ liccomc uic pro(ienx orlliii C its or S;inil I!nil aii+l iliall not lis rcturncJ ILIIOIIIOI)III! dainags Iroin a inolur velucle iiccidcni Jilt!a!11! prOl ide luo i:sliiu.iles l'or repaih or acl+ial hill lli.il lint been paid. I Illlltimobll( diuii;ige l'rom 11 blrcal dcl'cd or polliolv . plcasc I)TOI liiC Ill 0 eSllllluli:> lOr T(pJlrl Or actu.il 11111 iilJl 11(IS 11Atl paid iliiliin'ioliilc WaS loiicd <uid ma> ormay 11111 liaii: suslaincil Jainagc lilcase proiidv copi ol tmiingnckci til iiiiiiliimq). icccipi Ironi Impoiind Ihl. and liio sbluiiales ror icIiairs or acliivil liill lh.il liub Ix:cn paid Ill)W Eincrgcnc5 pleaqc pTovlac (OpV Oi 1011 lllg Inskgl (II al'Jllaltla) raccipl rTl)Ill lllilloulid LOI. .ulll lit 0 cstimates fiir rcpairs Or ncltial lull ilial li.b hcxi li.iiJ Propiirly Juiii:igc plc.ise proi nlc tuii eSlinlal(5 liir rcpairq u.ictu.il lull flint lias lii:cn liaid - 'iaou ii crc iBliucJ Jiiriug a motor s cliiJc acci&ni plcasc liro s ice piilice i cpon niimlicr, ilct.ii Is ulioui iniirv IJ 'l"Oll wl:ll! in3urcd m ilic Ciiy ol Siinil l'aul PII.!:L)I: ilrill iJv police raport niunher. iiitncsscq.inJ Jetiiils aliotit 1111111% 1 lils qeclliiii iiiiiql lic ciiiuplctcil fiii' iill cliiliiiq. Is ihcrv a policc icporl rot tlus ini:idciu" 'U li' ves. please proutk: Ilic Ixilicc icliorl cas: iiiimhcr R*labczi*ip @l pe&Vl big!ling to l'arli maling the Jimi pxma Daic doi:unieni ii beiiy si@ied 3 5 202] kaiaaJl y.rpi%r *(1,"