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7. Property Damage: <br />Name of Owner, if other than Claimant <br />Address of Owner, if other than Claimant (street, city, state, zip code) <br />Mailing Address of Owner (if different from above address) <br />Briefly describe kind and location of property and nature and extent of damage. <br />(See instructions for method of substantiating claim.) <br />8. Personal Injury (State nature and extent of injury which forms the basis of this claim.) <br />9. Witnesses: <br />Name Address Telephone No. <br />*PLEASE BE ADVISED THAT FILING OF YOUR CLAIM WITH THIS OFFICE DOES NOT FULFILL YOUR NEED TO <br />FILE A LAWSUIT IF YOU DISAGREE WITH THE DECISION ON YOUR CLAIM, REGARDLESS OF WHETHER YOUR <br />CLAIM IS TIMELY INVESTIGATED AND A REPLY MADE TO YOU WITHIN THE APPLICABLE PERIOD OF <br />LIMITATIONS WHICH MAY BE AS SHORT AS TWO YEARS. <br />7/10 <br />-2- <br />