20081003000207 - Appointment of Agent to Receive Claims.MI
III 11111111111111111111111111111
20081003000207
KING COUNTY, WA
Please print or type information WASHINGTON STATE RECORDER'S Cover Sheet (Rcw 65.04)
Document Title(s) (or transactions contained therein): (all areas applicable to your document must be filled in)
3. 4.
Reference Number(s) of Documents assigned or released:
Additional reference Ws on page of document
Grantor(s) Exactl as name(s),appear on document
1. G O� 1- _ 1)im\ rn
2.
Additional names on page of document.
Grantee(s) Exactly as name(s) appear on document
L (A Ai Ck �iAV ua , �QS1nt(lA n 5��
2.
Additional names on page of document.
Legal description (abbreviated: i.e. lot, block, plat or section, township, range)
Additional legal is on page of document.
Assessor's Property Tax Parcel/Account Number ❑ Assessor Tax # not yet
assigned
The Auditor/Recorder will rely on the information provided on this form. The staff will not read the document
to verify the accuracy or completeness of the indexing information provided herein.
"I am signing below and paying an additional $50 recording fee (as provided in RCW 36.18.010 and
referred to as an emergency nonstandard document), because this document does not meet margin and
formatting requirements. Furthermore, I hereby understand that the recording process may cover up or
otherwise obscure some part of the text of the original document as, a result of this request."
Signature of Requesting Party
Note to submitter: Do not sign above nor pay additional $50 fee if the document meets margin/formatting requirements
Return Address:
City of Federal Way
Attn: Law Dept.
P.O. Box 9718
Federal Way, WA 98063-9718
NOTICE OF APPOINTMENT OF AGENT
TO RECEIVE CLAIMS FOR DAMAGES PURSUANT TO RCW 4.96.020
Pursuant to RCW 4.96.020, as amended by EHB 1530, Chapter 119, Laws of 2001, and Federal Way City
Code (FWCC) Chapter 2, Article V, the City of Federal Way appoints the following as its agent to receive
any claim for damages made pursuant to RCW 4.96 and FWCC 2-156:
City Clerk
City of Federal Way
33325 8t' Avenue South
P.O. Box 9718
Federal Way, WA 98063-9718
The City Clerk may be reached at the above address during the normal office hours for the operation of
the City Hall as defined in FWCC 2-1, as it now exists or is hereafter amended.
Pursuant to FWCC 2-156 et. seq., no action for monetary damages against the city shall be commenced
until a written claim for damages has been properly presented and filed with the city clerk's office on a
form provided by the clerk. The claim must specify the name of the claimant, the claimant's address, the
date and location of the claimed loss, any alleged act or omission on the part of the city and the basis upon
which liability is being asserted against the city, any known witnesses, the nature and extent of the injury
or damage sustained, and the amount being claimed. All claims must be signed by the claimant and
notarized prior to filing.
CITY OF FEDERAL WAY
rol McNeilly, C, Ci C erk
P.O. Box 9718
Federal Way, WA 98063
(253) 835-2540
STATE OF WASHINGTON
ss.
COUNTY OF KING
On this day personally appeared before me Carol McNeilly, to me known to be the City Clerk of
the City of Federal Way, a municipal corporation that executed the foregoing instrument, and
acknowledged that said instrument to be the free and voluntary act and deed of said corporation, for the
uses and purposes therein mentioned, and on oath stated that she was authorized to execute said
instrument and that the seal affixed, if any, is the corporate seal of said corporation.
Given my hand and official seal this 10 day of September, 2008.
K:\Forms\Appointment of Agent for Claims
) \ �" 0- -T?bC:)ror
otary p in and for the state of Washington,
residing at to
My commission expire . th \—,-Lc -
I