Loading...
HomeMy WebLinkAbout11-18-2015 HEARING EXAMINER PACKETAUWRTN TY OF WASHINGTON HEARING EXAMINER November 18, 2015 5:30 p.m. City Council Chambers 25 West Main Street I. Case No: City of Auburn Police Police Case 15 -12326 Appellant: Katie Bergstrom 1514 33rd Street SE Auburn, WA 98002 Request: Appeal of Potentially Dangerous Dog Designation CITY OF ' WASHINGTON October 9, 2015 Nancy Backus, Mayor 25 West Main Street * Auburn WA 98001-4998 * www.auburnwa.gov * 253-931-3000 DELIVERED BY CERTIFIED AND FIRST CLASS US MAIL Appellant: Katie Bergstrom 1514 33rd Street SE Auburn WA 98002 CITY OF AUBURN NOTICE OF APPEAL HEARING Notice is hereby given that the city of Auburn Hearing Examiner will conduct a hearing on the appeal by Katie Bergstrom on the City of Auburn's designation of the dog known as "Sue" as a dangerous dog. The dog known as "Sue" is described as a maleLabrador/Retrievermix, brown in color. The hearing will be held Wednesday, November 18, 2015 at 5:30 p.m. in the Council Chambers of Auburn City Hall located at 25 West Main Street, Auburn, WA, 98001. DATED AND MAILED THIS 9th DAY OF OCTOBER. CITY OF AUBURN Danielle Daskam, City Clerk CC:: Richard and Linda Knowles AUBURN * MORE THAN YOU IMAGINED- ,Ip.mplo■••■ 1=n1=1=1113 1=111=121.11=1. IITRIEMME1111=1 =M=07 7516 6645 mm 0 1=1 O M 173 nJnJ rR r -1 ruru Cs, cD 0 CO Les ‹c 1.13 Z -r z 5 t-4 < LUCN ()0 0 E co OW 6 6 VI tin; < 6 03 E 7.1 " (0 in ‘- < Fol, del Iverrif I nIciritiatIciii ;741ti It iiiklietislte tit www.usps.Vomtt5S3 Postage Certified Feo Return Receipt Fee (Endorsement Required) Restricted Delivery Fee (Endorsement Required) Total Postaae i% Foes S Sent Srroo. or PC 04; Postmark Were Katie Bergstrom 1514 33rd Street SE Auburn WA 98002 o Compiete items 1, 2, and 3. Also complete item 4 If Restricted Delivery Is desired. La Print your name and address on the reverse so that we can return the card to you. ci Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: Katie Bergstrom 1514 33rd Street SE Auburn WA 98002 A. Signature X © Agent ❑ Addressee C. Date of Delivery C /0 D. Is delivery address Jiff, =nt from Item 17 14. 2. Article Number (Transfer from service labeO • Y If YES, enter delivery address below: ❑ No iervice Type I a Certified Mall ❑ Express Mall j* 7 Registered ❑ Retum Receipt for Merchandise ❑ Insured Mall ❑ C.O.D. Restricted Delivery? (Extra Fee) ❑ Yes I 7014 2120 0003 7516 6645 PS Form 3811, February 2004 Domestic Return Receipt .D 1I rR u1 r— m D D D D nJ ra nJ rR D N thS Pos aI Se CERwir IED Domes ilc,Mal(Only For delivery;inionttattoa,rvisitbir: ebsitTit ;wwwaspscom°. Postage Certified Fee Return Receipt Fee (Endorsement Required) Restricted Delivery Feu (Endorsement Required) yr Postmark Here r T r� T —.1f / Katie Berg strom' 1514 33rd Street SE Auburn WA 98002 Total Postage & Fees A 3 Sent -�rroe ar PC Crry, CITY OF AUBURN NOTICE OF APPEAL HEARING Notice is hereby given that the City of Auburn Hearing Examiner will conduct a hearing on the appeal by Katie Bergstrom on the City of Auburn's designation of the dog known as "Sue" as a dangerous dog. The dog known as "Sue" is described as a male Labrador /Retriever mix, brown in color. The hearing will be held Wednesday, November 18, 2015, at 5:30 pm in the Council Chambers of Auburn City Hall located at 25 West Main Street, Auburn, WA, 98001. Do Not Publish Below This Line Publish in The Seattle Times on October 14, 2015 WASHINGTON October 9, 2015 Nancy Backus, Mayor 25 West Main Street * Auburn WA 98001 -4998 * www.auburnwa.gov * 253 - 931 -3000 DELIVERED BY CERTIFIED AND FIRST CLASS US MAIL Appellant: Katie Bergstrom 1514 33rd Street SE Auburn WA 98002 CITY OF AUBURN NOTICE OF APPEAL HEARING Notice is hereby given that the City of Auburn Hearing Examiner will conduct a hearing an the appeal by Katie Bergstrom on the City of Auburn's designation of the dog known as "Sue" as a dangerous dog. The dog known as "Sue" is described as a male Labrador /Retriever mix, brown in color. The hearing will be held Wednesday, November 18, 2015 at 5:30 p.m. in the Council Chambers of Auburn City Hall located at 25 West Main Street, Auburn, WA, 98001. DATED AND MAILED THIS 9th DAY OF OCTOBER. CITY OF AUBURN Danielle Daskam, City Clerk CC: Richard and Linda Knowles AUBURN * MORE THAN YOU IMAGINED AUBURN POLICE DEPARTMENT ANIMAL CONTROL DIVISION corlidoupy ntrt °Cr 05 2015 c,r R IGHTS UPON NOTIFICATION OF PRELIMINARY DECISION o SVJ Oge\ er Dog 330.s\-s. Address Under ACC 6.35.020(C) you have a right to appeal the determination of the Chief of Police or his designee to present any reasons, orally or in writing, why the animal should not be declared Dangerous or Potentially Dangerous: If you fail to appear for this meeting preliminary notice will become final, and your animal(s) will be declared Dangerous or Potentially Dangerous. If, after the initial meeting date, your animal is declared Dangerous or Potentially Dangerous you may appeal that final declaration using this form. This form must be submitted to the City Clerk by certified mail or in person within fifteen (15) days of the determination ofyour animal's status if the original notification was delivered to you in person, or within twenty (20) days if the original notification was mailed to you. REQUEST FOR MEETING ON PRELIMINARY DECLARATION I request a meeting as provided for in ACC 6.35.020(C) to discuss the preliminary decision to declare my animal(s) as Dangerous or Potentially Dangerous in Case(s) No. 1S i 2-?2 . I understand that I have•the.right to present reasons or information in writing or verbally as to why my._ n al s) sh. . not be de ared Dangerous or Potentially Dangerous. Signature ._� ■�' �: titbit ti 11 Printed Name /Date Auburn City Clerk 25 W. Main St Auburn, WA 98002 -5548 Phone: 253 -931 -3007 CITY OF Police Depcartment WASH] NGTON 340 E Main St, Suite 201 * Auburn WA 98002 -5548 * www.auburnwa.gov * 253 -931 -3080 October 1, 2015 Ms. Bergstrom, On September 24, 2015, Officer Winner investigated a cornplaint regarding your Labrador Retriever "Sue" that was alleged to have bitten another dog causing severe Injuries, The Injuries required treatment by a veterinarian resulting In sutures to close the wound. Auburn Police Case 15- 12326. The owner of the victim dog stated they were walking on a sidewalk that borders your residence. As they walked by your wooden fence, Sue stuck his head through a hole and bit their dog causing the injury. Officer Winner located a vold in the fence along with what he believed was blood nearby. Sue was identified by the victim owner from a photograph. Officer Winner spoke with the veterinarian who confirmed that the victim dog did require surgery and sutures to treat the injury. You were contacted as a part of the Initial Investigation, and you denied Sue's involvement, On September 23, 2015, Officer Winner issued you a notice of Intent to declare Sue a Dangerous Dog as outlined in Auburn City Code. You requested a preliminary hearing on September 24, 2105. On September 28, 2015, you arrived in my office along with your friend, I afforded you an opportunity to provide information regarding this incident and any mitigating factors regarding the Dangerous Dog declaration. You began by saying that you have never had any Issues with Sue. Also, you provided photographs that illustrated your point that Sue could never have put his head through the fence given the slze of the hole. However, you did say it was possible that the victim dog may have put its face near the fence which could make the bite probable. After careful consideration from both the police Investigation and your testimony at our meeting, 1 as the designation official for the Animal Control Authority, have declared your dog Sue as Dangerous as described In Auburn City Code 6.01.010 (A) (13). Based on this declaration, you are required to follow the requirements outlined in Auburn City Code 6.35.030 and 6.35.035, as well as penalties associated with failure to comply, These codes can be accessed on the City of Auburn Web Site at Auburnwa.gov. According to Auburn City Code 6.35.010 (D), you may appeal my decision to the City's Hearing Examiner within 15 days of this notice, If it Is delivered to you In person, or within 20 days if the letter is mailed to you, by filing a written notice of appeal with the City Clerk. AUBURN * MORE THAN YOU IMAGINED CASE NUMBER: OFFICER:41 /...cix.,ZZ DATE ISSUED: 461/2.31/S AUBURN POLICE DEPARTMENT ANIMAL CONTROL DIVISION RIGHTS UPON NOTIFICATION OF PRELIMINARY DECISION tri E- pt. 3i,A57-RDA Owner 15[u .33''D ST L Address Dog Under ACC 6.35.020(C) you have a right to meet with the Chief of Police or his designee to present any reasons, orally or in writing, why the animal should not be declared Dangerous or Potentially Dangerous: If you are unable to attend this meeting you can request the meeting be rescheduled to a reasonable tune that falls within 10 calendar days of delivery of this notice. If you fail to appear for this meeting preliminary notice will become final, and your animal(s) will be declared Dangerous or Potentially Dangerous. lf, after the meeting date, your animal.is declared Dangerous or Potentially Dangerous you may appeal that final declaration using the form provided on the following page. This form must be submitted to the City Clerk by certified mail or in person within fifteen (15) days of the determination of your animal's status if the original notification was delivered to you in person, or within twenty (20) days if the original notification was mailed to you. REQUEST FOR MEETING ON PRELIMINARY DECLARATION I rec;aesr P. meeting Lis provided For in ACC 6.35.020(C) to discuss the preliminary decision tc. declare my animal(s) as Dangerous or Potentially Dangerous in Case(s) No. wmirArmu- APP / — 3) Understand that I have the right to present reasons or information in writing or verbally as to why my a 'i • .1(s) sho 1 of be declared Dangerous or Potentially Dangerous. P ► �l! i i iJ ' A� Si:nature £e(')STaY\A 24- 2015 Printed Name /Date 9I Lid Z . ;.! a .; �iAi3 �d Auburn Police Department 340 E. Main St. Ste. 201 Auburn, WA 98002 -5548 Phone: 253 - 931 -3080 Page 3 of 6 CASE NUMBER: 0 OFFICER: kilrwoa- AUBURN POLICE DEPARTMENT ANIMAL CONTROL DIVISION DATE ISSUED: Ai i$ NOTICE OF INTENT TO DECLARE A DOG AS A DANGEROUS ❑ POTENTIALLY DANGEROUS ENCLOSED: PACKET COVER SHEET (PAGE 1) REASON FOR DECLARATION (PAGE 2) HEARING NOTIFICATION FORM (PAGE 3) REQUIREMENTS (PAGE 4 & S) INSURANCE FORM (Page 6) Owner / Keeper of Dog: Last Name: �I;iq..G� First: k4'r7c_ MI: /" t DOB: Address: i$i4 33 1) ,6-50 City: /11414ivii State: Zip: Home Phone , 2,6.c."- A.2.69 Z Work Phone: Description of Dog: n- Namex,SA.E Breed(s): Z17.3 r T color(s): Markings: ‘S'ac.lf.P Sex: 'F. Altered: �f N Age: Microchip / Tattoo: gr&L .- erAVIA4 v License year and number: 02.-271- I$ Rabies Vaccination Exp. Date: Veterinarian Name:_ Veterinarian Phone: Whereabouts of dog if not at owner /keeper's residence: — (ft )90(44 ‘,V-(iks.W TO v7/.0 ••,,. Page 1 of 6 CASE NUMBER: 1$ x2324 OFFICER: M-("' DATE ISSUED: AUBURN POLICE DEPARTMENT ANIMAL CONTROL DIVISION TYPE AND BASIS OF DECLARATION & REASONING Auburn Animal Control is seeking to declare your d og: Dangerous Potentially Dangerous At approximately 1O6-0 hrs. on the 3f'a day of 41-4.46.47— 7 , 2-0 . Animal Control has witnessed or been provided evidence that your animal '.0 KC 9lifitoc. iB- 311AJ6 tr eD, &/' LW/it/ $i ye (.02 ihmAs L r' R s?r Jam` ************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Narrative: ..S r frro 60,ce iQV -z. Page 2 of 6 CASE NUMBER: 15--/23 OFFICER: J/ '7 DATE ISSUED:Cr�� AUBURN POLICE DEPARTMENT ANIMAL CONTROL DIVISION RIGHTS UPON NOTIFICATION OF PRELIMINARY DECISION gh-ent fl . QrAw Owner Dog pstq 3Y'0 5-0- se- Address Under ACC 6.35.020(C) you have a right to meet with the Chief of Police or his designee to present any reasons, orally or in writing, why the animal should not be declared Dangerous or Potentially Dangerous: If you are unable to attend this meeting you can request the meeting be rescheduled toa reasonable time that falls within 10 calendar days of delivery of this notice. If you fail to appear for this meeting preliminary notice will become final, and your animal(s) will be declared Dangerous or Potentially Dangerous. If, after the meeting date, your animal is declared Dangerous or Potentially Dangerous you may appeal that final declaration using the form provided on the following page. This form must be submitted to the City Clerk by certified Mail or in person within fifteen (15) days of the determination of your animal's status if the original notification was delivered to you in person, or within twenty (20) days if the original notification was mailed to you. REQUEST FOR MEETING ON PRELIMINARY DECLARATION I. request a meeting,as_provided for in ACC 6.35.020(C) to discuss the preliminary decision to declare my animals) as Dangerous or Potentially Dangerous in Case(s) No. /S /2.2 . I understand that•I have the right to present reasons or information in writing or verbally as to why my animal(s) should not be declared Dangerous or Potentially Dangerous. Signature Printed Name /Date Auburn Police Department 340 E. Main St. Ste. 201 Auburn, WA 98002 -5548 Phone: 253 - 931 -3080 Page 3 of 6 CASE NUMBER: 1--/2.321.7 OFF! CERA. /4•w14- DANGEROUS DOG REQUIREMENTS DATE ISSUED: 01 Within twenty (20) days of receipt of this declaration, you are required to obtain a certificate of registration and a special license for your Dangerous Dog from the Auburn City Clerk. The license will be issued upon compliance with the following requirements: 1. Per ACC 6.35.020 {0(1): Placement of a "proper enclosure" on the owner's / keeper's property to confine the dog. 2. Per ACC 6.35.020(0(1): Placement of a conspicuously displayed sign on the premises where the dog is harbored with a warning symbol that informs children or adults who cannot read of the presence of a dangerous dog. 3. Per ACC 6.35.020(0(2): A surety bond issued by a surety insurer qualified under chapter 48.28 R.C.W. in a sum of not less than $250,000 payment to a person injured by the dog, or a policy of liability insurance issued by an insurer qualified under title 48 R.C.W. in an amount not less than $250,000 insuring the owner or keeper for personal injuries inflicted by the dog. (OR) 4. Per ACC 6.35.020(0(3): A policy of liability insurance, such as homeowner's insurance, issued by an insurer qualified under RCW Title 48 in the amount of at Least $250,000, insuring the owner for any personal injuries inflicted by the dangerous dog, or such liability insurance that otherwise meets the requirements of RCW 16.08.080. 5. Per ACC 6.35.080 (A): If the Dangerous Dog is taken outside the required enclosure, such dog shall be muzzled and restrained by a substantial leash or chain and under the physical control of a person sixteen (16) years or older who is capable of restraining such animal. 6. Per ACC 6.35.020 (g): Any dog which is declared to be a "dangerous dog" pursuant to this chapter or Chapter 16.08 RCW shall also be required to be microchipped.by a veterinarian of the owner's choice, at the owner's expense. This shall be in addition to the other requirements of this chapter and in addition to the applicable requirements for licensing as defined within this title, and this procedure must be accomplished within 30 days after the owner's receipt of the dangerous dog declaration issued pursuant to this chapter or Chapter 16.08 RCW. 7. The special license fee for a Dangerous Dog is $500.00 per year, in addition to the regular license fee. Page 4 of 6 CASE UMBER: OFFICER: DATE ISSUED: POTENTIALLY DANGEROUS DOG REQUIREMENTS Within twen (20) days of receipt of this declaration you are required to provide obtain a certificate of registration an. a special license for your Potentially Dangerous Dog from the Auburn City Clerk. The license will be iss . ed upon compliance with the following requirements: 1. Per ACC 6.35. ∎ 30: Placement of a "proper enclosure" on the owner's / keeper's property to confine the dog. 2. Per ACC 6.35.030 If the Dangerous Dog is taken outside the required enclosure, such dog shall be restrained by a sub tantial leash or chain and under the physical control of a person sixteen (16) years or older who i capable of restraining such animal. 3. Per ACC 6.35.035: Th - notice of potentially dangerous dog form, available from the city clerk, shall be filed. 4. Per ACC 6.35.035: The sp -cial license fee for a Potentially Dangerous Dog is $100.00, and the annual renewal fee is $10 1 1 0. Page 5 of 6 CASE NUMBER: 13-17-334" Owner /Keeper of dog: OFFICER M/wa- DATE ISSUED:e9ct /z / S AUBURN POLICE DEPARTMENT ANIMAL CONTROL DIVISION DANGEROUS DOG INSURANCE REQUIREMENT FORM Last Name: First: MI: DOB: Address: City: State: Zip: Home Phone: Work Phone: Description of dog: Name: Breed(s): Color(s): _ Markings: Sex: M/F Altered: Y/N Age: Microchip / Tattoo: TO INSURANCE /BOND AGENT: The above described animal has been declared a Dangerous Dog by the Auburn Police Department Animal Control Division per ACC 6.01 and 6.35, due to: Per ACC 6.35.020(f)(2) &(3): The owner /keeper of this animal must obtain a surety bond issued by . a surety insurer qualified under chapter 48.28 R.C.W. in a sum not less than $250,000 payable to a person injured by the dog, and a policy of liability insurance issued by an insurer qualified under title 48 R.C.W. in an amount not less than $250,000 insuring the owner or keeper for personal injuries inflicted by the dog. Additionally, written notice must be provided to the City of Auburn Police Department within 30 days of cancellation, reduction of limits, or termination of coverage. •`F: _ =a` �'�,�:�� '�o''IRS�:�';,Y '9. • .��w: r.; _ � � '•W :� •aidl'•�.. a �:. 'tip..,:: i. � -r • ;'^ :`RL�.:':ze a .: late.a ,si n'; sq: {-11p: .,,with ' a = opy' of,tFi' oll 4;tok_thE± Auburn Pc lice eas -camp �- J3 .,tl� far'r�; ,ari�-:f t � :copy •�I? cY ,f• "� a �' °_.:,. %: "rr e artrrient .Atvmat Co ` troI Dlvisihin, 340 �E tiMa n Stree ;:5te �ZOZ .`Ai b `rn INei7 :980 ,('253);93 -3080f1 '! �.. �4; 7�. r-: � � -4_ . ti . �,. .�r'' ;� •9Y .. .:. �r •„a,}..•..��� " .' °MS- i •'x. �7:� - 'cy,.� - r�.r.� d .. ., -r 'n �'c�::- •_ "•' d' s7;;,' 41, �:.. €.:•,r...��- .- ��r,':i }'4' -y k You .... FAX=(253):931 =5108 han ��:;:• • • ��,��= �.... V� .�::.r .,�.�� __ . ' ;: • .. - �°�- F,. �= -. Insurance /Bond Agent: Name: Address: Phone: Date: Company Name: Policy Number: Insurance /Bond. Ag Page 6 of 6 AUBURN POLICE DEPARTMENT STATEMENT ❑ SUSPECT ❑ VICTIM Date: �i " ;2-3 r I5 Time/Hours: 0.35 Case :/S /2Y2- WITNESS Number- Statement of Twjth-Oct...,9 Taken by: (N . (J 1 M/4 12-- qg)$ Date of Birth: Address: Place: (Au t /4era-G /14- Age: Alias: q 2-1 ply C Work Phone #: /22 Home Phone #: Cell Phone #: (,/ iz`.0 4 —1 4 / /,vii 4APILf/ -repAer/ povte. zfr2-',6-e, #1,e ai t›(2,_ A Gfr 1119t Chi 1-51174. J e e.-- r / J LLV( , 49 c .- ®dt- Cl [B .14 7A1A11. 1,, Pa- iC 42-1/te--c, z",:`"P L� 9AtQA i �i 0 7J' D. d ha,J, /6),, I certify under penalty of perjury under the Laws of the State of Washington, that the above statement is true and correct. Statement, B (01/09) Page L of .( Auburn Police Department Police Report for Incident 15 -12326 10/01/15 11:15:05 538 Crime: ANPR ANIMAL PROBLEM Location: 6 -328 Received By: G Winner Responding Officers: G Winner Responsible Officer: D Jones When Reported: 12:33:51 09/23/15 How Received: Disposition: Occurred Between: Address: 1514 33RD ST SE Auburn WA 98002 V Valley Comm Agency: APD CLEARED ADULT ARREST 09/24/15 10:45:00 09/23/15 and 11 :00 :00 09/23/15 Crimes Additional Offense: Animal Injuring Human Circumstances LTN51 Street/Highway /Road/Alley GG03 No Gang/Unknown Clearance: CRO Cleared, Responding Officer Judicial Status: Misc Entry: MJ Modus Operandi: Involvements Date 09/24/15 09/24/15 09/24/15 09/24/15 09/24/15 09/23/15 09/23/15 09/29/15 09/24/15 Type Name Name Name Name Name Citation Citation Offense Property Description : Description KNOWLES, RICHARD LADELL KNOWLES, LINDA J SUMNER VETERINARY HOSPITAL, BERGSTROM, KATIE M BERGSTROM, WILLIAM EUGENE Other Criminal Citation Animal Injuring Human - 1 count BRO Dog Lab Retriever X "Sue" male 0 Method : Relationship WITNESS WITNESS OTHER ARRESTED OTHER Citation Citation Charged With 111 10/01/15 Police Report for Incident 15 -12326 Page 2 of 7 Involved Persons (Most current address on 10/01/15): ARRESTED: Last: BERGSTROM First: KATIE DOB: 05/10/89 Dr Lic: BERGSKM 113KS Race: W Sex: F Phone: (206)265 -2202 Height: 5'06" Weight: 135 Hair: BRO Eyes: BRO Mid: Address: City: SSN: Work Phone: M 1514 33RD ST SE Auburn, WA 98002 0 - WITNESS: Last: KNOWLES DOB: 10/18/56 Race: W Height: 5'11" Hair: BLU Sex: M First: Dr Lic: Phone: Weight: Eyes: RICHARD KNOWLRL445PQ (253)931 -1106 212 GRY Mid: Address: City: SSN: Work Phone: LADELL 3421 Pike St SE Auburn, WA 98002 0 - WITNESS : Last: KNOWLES DOB: 10/20/49 Race: U Height: ' " Hair: Sex: First: Dr Lic: F Phone: Weight: Eyes: LINDA KNOWLLJ513P0 {)- 0 Mid: Address: City: SSN: Work Phone: 3 3421 PIKE ST SE Auburn, WA 98002 0- OTHER: Last: SUMNER VETERINARY HOSPITAL DOB: Race: Height: Hair: I PI Sex: First: Dr Lic: Phone: ()- Weight: 0 Eyes: Mid: Address: City: SSN: Work Phone: 16024 60TH ST E Sumner, WA 98390 (253)863 -2258 OTHER: Last: BERGSTROM DOB: 05/04/87 Race: W Sex: M Height: 5'09" Hair: BLU First: Dr Lic: Phone: Weight: Eyes: WILLIAM BERGSWE 134KD {)- 180 BLN Mid: EUGENE Address: 1514 33RD ST SE City: Auburn, WA 98002 SSN: Work Phone: () - 10/01/15 Police Report for Incident 15 -12326 Page 3 of 7 Narrative G WINNER 49505 105A NV Thu Sep 24 07:21:44 PDT 2015 A dog reached through its fence, biting another dog walking by its property on a leash. The biting dog was impounded and declared a Dangerous Dog due to the severity of the injury.1 On 09 -24 -15 I was dispatched to 1514 33rd St SE for a dog bite issue. The RP had advised that his dog had been bitten by a dog at this address. The RP resided at 3421 Pike St SE. I contacted the RP, verbally identified as Richard Knowles, and his wife at their residence. The Knowles were both witnesses to the incident. Both of their stories matched up. The Knowles advised their dog, "Taffy ", was immediately taken to Sumner Vet for surgery following the incident. I later called Sumner Vet and confirmed with the attending Veterinarian that the dog would require surgery and suturing of some sort to close the injury. The Vet advised the dog was expected to make a full recovery. Sumner Vet provided me their estimate for the care of the dog at $450 -$744. I requested Knowles let me know what their final amount for Taffy's care was. Richard's statement detailed taking Taffy for a walk around 1050 Hrs today. While heading back from Game Farm Park they walked by the fence of 1514 33rd ST SE, along R St SE. This location is along the route they would take to get home. At a hole in the fence, a chocolate Labrador Retriever (Lab.) stuck it's head through and grabbed their dog by the lower jaw causing puncture type injuries. The Knowles then took their dog to the Sumner Vet for treatment. In speaking with the Knowles they said they have had issues walking past this fence before, due to the two dogs inside barking and acting aggressive when they walk by. Typically, the Knowles advised, if they know that dogs are out due to seeing or hearing the dogs, which they usually hear barking as they approach the fence, they avoid walking by this house. Today, the Knowles said, they had no prior indication that the dogs were in the yard, so they kept walking towards their home on the sidewalk. The prior issues they've had have never resulted in a dog sticking it's head through the fence or any bites. I proceeded to 1514 33rd St SE. I located the hole in the fence at the southwest corner of their property, along the sidewalk. I was later able to locate some dried drops of maroon liquid on the sidewalk, among maroon colored leaf litter. The drops appeared to be blood. I took several photos of the area. In The Knowles statement to me they had indicated a "Cable Box" that was at the hole in the fence. I notice the house at the northwest corner of 33rd and R St SE had a large electrical box sitting at the southwest corner of the yard. I did not notice a hole in this area. I contacted the dog owner, Bergstrom, Katie M., at her residence, 1514 33rd ST SE. I advised her of the complaint. Bergstrom said she had not heard anything of the sort, and she had been home at the time. Bergstrom said her Lab, "Sue ", a male, chocolate, Lab, had a hematoma on her ear, and she didn't believe that her dog had done something of the sort. Bergstrom said she had never had an issue prior with either of her dogs being aggressive towards other dogs. I asked Bergstrom if she would allow me to photograph her dog, to rule out any doubt about the animal involved. I figured the Knowles were correct with the address they had given, but to assuage Bergstrom's fears I asked permission for the photograph. She brought the dog out and allowed me to take a photo. I returned to the Knowles, showing them the photos I had taken of the hole in the fence and the dog. Both Linda and Richard confirmed that the house had a Lab and a Shepherd in the yard, the address was correct, and the photos I had shown them were of the correct area and the correct dog which had bitten Taffy. I returned to Bergstrom and advised that the family had no doubts about Sue being involved. I advised Bergstrom that I was impounding Sue, and she would be I0 /011l5 Police Report for Incident 15 -12326 Page 4 of 7 declared a Dangerous Dog. Bergstrom said I would need to return with a warrant in order to impound her dog. I suggested she not make the situation worse by interfering with me impounding Sue, as that was another criminal matter. At that time, Bergstrom didn't care. I returned to my vehicle to prepare the Dangerous Dog declaration, citations, and infractions for this case. Upon completing the paperwork I returned to Bergstrom's door. She was much slower to answer, when she came to the door she was visibly crying. Bergstrom said she had called her husband. She asked if I could wait for his arrival to speak to him. While waiting I handed Bergstrom the Dangerous dog declaration packet. She refused to sign my copy for receipt of such. I was unable to explain the packet in depth to Bergstrom, she returned inside. Around 1350 Hrs William Bergstrom arrived, identified verbally. I explained the circumstances to him, and walked him through the events as they had been explained to me. While looking over the fence again I located what appeared to be dried blood drops on the sidewalk, just south of the hole in the fence. I photographed the drops at that time. William said they were aware of the hole, and advised they had tried to cover it up on multiple occasions. William said he had to replace the cover on the box at the hole around once a month, advising that he knew that there were a lot of bums in the area and he believed they would walk by in the night and "just mess with stuff ". I suggested William place a wood frame around the hole, on the inside of the fence, and cover it to prevent any future issues with any other dogs. The fence board directly above this hole was set higher than the rest on the fence line. The movement of the fence board did not appear to be recent given the amount of dirt and debris sitting against the board and its cross members. The dirt and debris did not appear to have been recently moved or disturbed. The board also did not show a difference in coloration suggesting the board had been moved recently. William asked if he could go inside and talk the issue over with his wife. I also advised William of the interference with impound municipal code. Minutes later I returned to the door and William had brought Sue out to the truck on leash. Sue was loaded onto my truck and the family said their good -byes to her for the time being. I explained the Dangerous Dog packet to William. I advised of the appeal process and their requirements, to be met within 20 days, before being able to have Sue released back to them. William thanked me and apologized for the time the matter had taken. I did the same. I provided William the Humane Society's card for his reference, as well as my card with the case number. The packet also detailed the dog's impound. I checked Licensing records for the address. I had spoken to Bergstrom around seven dr eight months prior, picking up a stray dog from her at her house. At that time I warned her to license the dogs. While it appeared she had attempted to do so, the Licenses for both dogs at this location were not yet valid. Both were listed as "Due - Pending Exception ". The licenses appear to have a late fee associated that still needs to be paid. Before leaving I printed Katie Bergstrom's citations and infractions, and handed them to her, advising of her court date, time and location. The citation was for AMC.602.090 (ANIMAL INJURING HUMAN OR DOMESTIC ANIMAL). The infractions included AMC6.02.010.A.1 (ANIMAL AT LARGE 1ST OFFENSE), AMC6.02.130.I (ANIMAL INSURE PRIVET /PUBLIC PROPERTY), and 2x AMC6.04.010 (FAILURE TO LICENSE). All these were issued for 1050 Hrs on 09 -23 -15 according to Knowles' statement. 10 /01 /15 Police Report for Incident 15 -12326 Page 5 of 7 I CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT ALL STATEMENTS MADE HEREIN ARE TRUE AND ACCURATE AND THAT I AM ENTERING MY AUTHORIZED USER ID AND PASSWORD TO AUTHENTICATE IT. Signature:George D Winner {x:9505 Date and Place:09 -24 -15 City /Town of Auburn, County of King 10 /01/15 Police Report for Incident 15 -12326 Page 6 of 7 Supplement Sequence:l G WINNER #9505 105A NV Thu Oct 31 10:45:58 PDT 2015 On 10 -01 -15 I was presented a letter of determination of a Dangerous Dog Hearing, which was upheld. The letter was addressed to Katie Bergstrom, the dog owner. Around 1000 Hrs I arrived at Bergstrom's residence. She had jsut arrived home, exiting her vehicle. I contacted Bergstrom, advised her of the paperwork, and handed her a copy, included was an Appeal Request form to be submitted to the City Clerk's office. I had Berstrom sign the original letter for proof of receipt. Both a copy of the letter and a copy of the Appeal Form will be added to the case jacket. Bergstrom advised they had the items needed, aside from a kennel for a proper enclosure for Sue. I reminded Bergstrom to contact me when they had all the requirements in place, so Sue could be returned to the property, pending payment of fees. I also contacted the victim dog owner, Linda Knowles, at her residence, 3421 Pike St SE. Knowles dog, Taffy, was also at home. Taffy was wearing an Elizabethan Collar {E-Collar). Knowles provided me a copy of her vet bill, to date, totalling $606.23. Knowles also advised she had a follow -up appointment on October 8th to remove the stitches from her dog's chin. Knowles did not know what the final cost would be at that time. Knowles also advised that if the area was injured while healing there would be little the veterinarians could do to rescure the skin; it would require plastic surgery. Knowles also advised that currently Taffy was on a soft food diet, and she was also on medication for pain and antibiotics. Later, I arrived at Sumner Vet to obtain the photos taken at the time of surgery, by the attending vet. I CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT ALL STATEMENTS MADE HEREIN ARE TRUE AND ACCURATE AND THAT I AM ENTERING MY AUTHORIZED USER ID AND PASSWORD TO AUTHENTICATE IT. Signature:George D Winner #:9505 Date and Place:10 -01 -15 City /Town of Auburn, County of King 10/01/15 Police Report for Incident 15 -12326 Page 7 of 7 Property Property Number: 226962 Item: Dog Owner Applied Nmbr: Brand: Lab Retriever X Model: "Sue" male Year: 2011 Quantity: 1.0 Meas: Serial Nmbr: Total Value: $0,00 Color: BRO Owner: BERGSTROM KATIE M 377612 Agency: APD Auburn Police Department Tag Number: Accum Amt Recov: $0.00 Officer: G Winner UCR: UCR Status: Local Status: CI Storage Location: AVHS Crime Lab Number: Status Date: 09/23/15 Date Released: * * / * */** Date Recov /Revd: * * / * * / ** Released By: Amt Recovered: $0.00 Released To: Custody: * *; * *: ** * * / * * / ** Reason: Comments: 10 /01/15 CAD/Ti Detailed History for Police Inc #AP150068845 As of 9/29/2015 19:03:55 Output fojr: AP3135 Priority:4 Type:ANIMAL - Animal Complaint Location:1514.33RD ST SE, AUB btwn PIKE ST SE and R ST SE Created: 09/23/2015 11:52:08 CRO7 V01120 Entered: 09/23/2015 11:54:07 CRO7 V01120 Dispatch: 09/23/2015 12:23:29] APM529 AP9505 LAP9505 AP9505 LAP9505 Enroute: 09/23/2015 12:23:35 (APM529 (APM529 (APM529 Onscene: 09/23/2015 12:24:25 Closed: 09/23/2015 16:43:59 ICUnit: PrimeUnit:8A9 Dispo:A Type :ANIMAL - Animal Complaint Agency:AP Group:Al Beat: RD:AP6328 Case #:CAP150012326 ❑ Detail Page 1 of 2 11:52:08 CREATE 11:54:07 ENTRY 11:54:07 - SELECT 11:54:07 - NPREMS 11:54:09 NOMORE 11:57:50 -HOLD 11:59:11 STACK 12:23:29 *DISP 12:23:35 *ENRTE 12:24:25 *ONSCN 12:33:51 CASE 12:51:16 *RFT 12:53:29 *MISCN 13:07:08 *MISCN Location:I514 33RD ST SE, AUB Type:AN1MAL Name:KNOWLES,RICHARD /OWNER RPaddr:3421 PIKE ST SE Phone:253 /931 -1106 Group:Al RD /MapBox:AP6328 TypeDesc:Animal Complaint LocDesc:btwn PIKE ST SE and R ST SE Priority:4 Class:F:1AC Agency:AP LocTvpe:S RPCon ?:Y Comment:1 HR AGO, RP'S DOG ATTACKED BY DK SRO LAB THAT BROKE THRU FENCE AT LOCN, *CONTACT RP AT 3421 PIKE ST SE, AUB* Comment:(none) SA9 SA9 Operator:AP9505 OperNames:WINNER, GEORGE 8A9 SA9 SA9 Case #:CAP150012326 SA9 Comment:INQUIRY CADQ ,,, „,,,,,,,,,AQS3624,,,,,,,, S:\9 Comrnent:SUMNER VET HAD THE DOG. PREPING FOR SURGERY NOW. ADVD SHE WILL NEED SUTURES, SOFT TISSUE INJURY TO MANDIBLE AREA. VET WILL BE TAKING PHOTOS, AS WELL. SA9 Comment:OWNER, KATIE M BERGSTROM, UNSURE, BUT BELIEVES HER DOGS WERE INSIDE AT THE TIME. 13:07:39 *CHGLOC 8A9 Location:3421 MICE ST SE, AUB 13:12:35 *MISCN 8A9 Conmment:PHOTO OF DOG AND DESCRIBED AREA, CONFIRMED WITH VIC OWNERS. SAME DOG. "SUE” PER LICENSING. 13:13:47 *ONSCN 8A9 13:14:47 *CHGLOC 8:A9 Location:1514 33RD ST SE, AUB 13:15:24 *ONSCN 8A9 13:16:50 *RFT A: \9 Comment:INQUIRY WANT,BERGSTROM, KATIE M, 05101989,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 13:41:43 *MISCN 8A9 Comment:VET QUOTED $450 -744. ESTIMATE FOR SURGERY FOR TAFFY, VICTIM DOG. 8:19 Comtnent:ADVD OF IMPOUND, BERGSTROM REFUSED. ADVD OF MISDEMEANOR ISSUE. WISHED TO CALL HER HUSBAND. SA9 Comment:WAITING FOR HUSBAND TO ARRIVE. 5:A9 Comment:INQUIRY CADQ ,,,,,,,,,,,,,,AQS3624,,,,,,,, 8A9 Comment:INQUIRY SPAWN,BERGSWE134KD, S:..9 Comment:INQUIRY CADQ ,,,,,,,,,,,,,,C31263C,,,,,,,, 8A9 Comment:JUST ARRIVED. ADVD OF SITUATION. SPEAKING TO WIFE NOW. 13:49:47 *MISCN 14:18:58 *MISCN 14:20:48 *RFT 14:20:56 *RFT 14 :39:03 *RFT 14:39:39 *MISCN http: l/ vcc- tib- webB780LiveCAD/ Html/SystemDocs /CADlnterface.aspx ?_CMD= CHQ &... 9/29/2015 CAD /Ti 15:00:01 *M1SCN 15:03:47 -STACK 15:21:17 *D1SP 16:39:08 ONSCN 16:43:59 *CLEAR 16:43:59 -PRIU 16:43:59 -CLEAR 16:43:59 *CLOSE 8A9 Comntent:IMPOUNDED DOG. SA9 S;A9 Operator:AP9505 OperNames:WJNNER, GEORGE $A9 Location:SHELTER 8_A9 Dispo:A Comment:STILL NEED PAPER. 889 Page 2 oft CONTACT INFO: Name IKNOWLES,RICHARD /OWNER Phone [253/931 -1106 RPaddr 342i PIKE ST SE RPCon? Y 1DCCode AltPhn RPCon4 r http: / /vcc -tib- web/ B780LiveCAD/ Html/ SystemDocs /CADlnterface.aspx ?_CM D= CHQ &... 9/29/2015 CRIMINAL U TRAFFIC ✓ANON- TRAFFIC LEA ORI#:WA0170100 COURT ORI 5' WA017173J IN THE, EDlSTRICT Q MUNICIPAL COURT OF KING COUNTYDISTRICT COURT STATE OF WASHINGTON COUNTY OF 1.1 ✓2 CFTY/TOWN OF AUBURN CITATION #: 5Z0720736 REPORT #: 15 -12326 PLAINTIFF VS. NAMED DEFENDANT DRIVER'S LICENSE NO. BERGSKM113KS STATE WA 711E UNDERSIGNED CERTIFIES AND SAYS THAT IN THE STATE OF WASHINGTON EXPIRES PHOTO I.O. MATCHED NAME: LAST YES N0; FIRST 05 -10 -17 !BERGSTROM KATIE ADDRESS 151433RD ST'SE UIF NEW ADDRESS MIDDLE MARIE SFX CRY AUBURN STATE WA EMPLOYER EMPLOYER LOCATION DATE OF BIRTH 05 -10-89 VIOLATION DATE INTERPRETER NEEDED ON OR ABOUT 09123!201510:50 u1G RACE W SEX F CDLICIP YES .0 a _I 0 Z o, N' NO 0 ZIP CODE , 98002- !HEIGHT : WEIGHT 5'03" 130 !EYES HAZ HAIR BRO !RESIDENTIAL PHONE NO. CELL/PAGER PHONE NO. 12061265.2202 WORK PHONE NO. AT LOCATION R ST SE REF. TRAFFICWAY 33RD ST SE MP. BLOCK # 3300 CITY/COUNTY OF AUBURN/KING _ 0 a - Z C VEH LIC NO STATE EXPIRES VE DID OPERATE THE FOLLOWING VEHICLE!MOTOR VEHICLE ON A PUBLIC HIGHWAY AND H YR MODEL !STYLE MAKE COLOR TR #1 LIC NO STATE EXPIRES TR YR 11R #2 LIC NO !STATE EXPIRES TR YR OWNERICOMPANY IF OTHER THAN DRIVER ADDRESS CITY !STATE ZIP CODE ACCIDENT lBAC COMMERCIAL VEHICLE ES NO. 16+ LIVES PASS I INO !H''T F YES NO EXEMPT VEHICLE' FIRE LEA 1. VIOLATION/STATUTE CODE AMC6.02.090 DID:THEN AND THERE COMMIT EACH OF THE FOLLOWING OFFENSES 110 V.IANIMAL INJURING HUMAN 2. VIOLATION/STATUTE CODE 1113 V• . 3. VIOLAT1ONISTATUTE CODE U D V 4. VIOLAT1ONISTATUTE CODE 1113 V 5. VIOLATIONISTATUTE CODE UDV . MANDATORY COURT APPEARANCE APPEARANCE DATE 10.01.15 TIME 8:45 AM RELATED # 2 OF 2 'DATE ISSUED 09 -23-15 QTICKET SERVED ON VIOLATOR f TICKET REFERRED TO PROSECUTOR I11CKEF SENT TO COURT FOR MAILING p BOOKED CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT HAVE ISSUED THIS ON THE DATE AND AT THE LOCATION ABOVE. THAT I HAVE PROBABLE CAUSE TO BELIEVE THE ABOVE NAMED PERSON COMMITTED THE ABOVE OFFENSE(S), AND I AM ENTERING MY AUTHORIZED USER ID AND PASSWORD TO AUTHENTICATE IT. OFFICER GEORGE WINNER OFFICER # 9505 COMPLAINT! CITATION ABSTRACT OF JUDGMENT CHG# I RESPONSE CHG 1 DISPOSITION' J FINES 1 SUSPENDED SUBTOTAL FINDINGIJUDGMENT DATE TO SERVE DAYS 1 G NG - 1 G NG 0 1 5 I S :2 W DAYS SUSP 2 0 NG ! 1 0 NG D ': � 1 S IS 5 ABSTRACTMLDTOOLYMPIA CREDITITIMESVD. Y!N 3 G NG 1 1 G NG D f 15 1 S :5 LIC. SURR, DT 4 G NG 1 G NG ❑ _ '-.' 1 S I S .2 TOTAL COSTS S REC. NONEXTENSION OF SUSP. Y I N 5 G NG I 1 G NG D ;, 1 S I S 5 .PAGE 1' OF 2 690 LSO IM 311d)I '161OaLSO2:139 OFFICER REPORT 520720736 VIOLATION DATE ON OR ABOUT: 979/2015 10:50:00 AM Attached and incorporated with APD Case #15- 12326. Officers Report for Citation /Notice of Infraction # 5Z0720735, 5Z0720736. The information contained imand attached to this citation /notice of infraction is incorporated by reference into this report. I CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT ALL STATEMENTS MADE HEREIN ARE TRUE AND ACCURATE AND THAT I AM ENTERING MY AUTHORIZED USER ID AND PASSWORD TO AUTHENTICATE IT. Signature: GEORGE WINNER #: 9505 Date and Place: 9/23/2015 City/Town of Auburn, County of KING WEATHER STREET LIGHT WITNESS NAME (LAST, FIRST. M.I.) KNOWLES, RICHARD. L PHONE 2539311106 WITNESS NAME (LAST. FIRST, M.I.) PHONE ADDRESS 3421 PIKE ST SE CITY AUBURN STATE ZIP WA 98002 ADDRESS (CITY STATE ZIP WITNESS, NAME (LAST. FIRST. M.L) PHONE WITNESS NAME (LAST. FIRST, M.I. ) PHONE ADDRESS ICrTY STATE ZIP ADDRESS CITY STATE ZIP WITNESS NAME (LAST, FIRST, M.I.) PHONE WITNESS NAME (LAST. FIRST, M.I.) PHONE ADDRESS ICrrY STATE ZIP ADDRESS ICtTY STATE ZIP WITNESS NAME (LAST. FIRST. M.I.) PHONE WITNESS NAME (LAST, FIRST. M -I.) - PHONE ADDRESS ICITY STATE ZIP ADDRESS K- STATE ZIP PAGE 2 OF 2 620190 W ALLYN'WO211.S0L13B INFRACTION QTRAFRC ©1405I-TRAFFIC LEA WA0170100 WA017173J INFRACTION 6: 5Z0720735 REPORTIY. 15.12326 IN THE DISTRICT ❑ MUNICIPAL COURT OF ▪ STATE OF WASHINGTON ©COUNTY OF KING COUNTY DISTRICT COURT CRY/TOWN OF AUBURN PLAINTIFF VS. NAMED DEFENDANT DRIVERS LICENSE NO. BERGSKM113KS STATE WA. EXPIRES 05 -10 -17 THE UNDERSIGNED CERTIFIES AND SAYS THAT IN THE STATE OF WASHINGTON PHOTO LD.'MATCHED NAME: LAST FIRST DYES �J NO BERGSTROM KATIE MIDDLE. MARIE SFx ADDRESS 1514 33RD ST SE IF NEW ADDRESS El PASSENGER CITY AUBURN STATE WA CDUCLP 0 YES I NO ZIP CODE 98002 EMPLOYER EMPLOYER LOCATION DATE OF BIRTH 05.10.89 RACE S W F [HEIGHT 5'03" WEIGHT EYES HAIR 130 - 1HAZ BRO RESIDENTIAL PHONE NO. VIOLATION DATE INTERPRETER NEEDED ON OR ABOUT 0912 312015 10:50 LANG: AT LOCATION R ST SE REF. TRAFFICWAY 33RD ST SE VEH LIC NO STATE EXPIRES DID OPERATE THE FOLLOWING VEHICLEAMOTDR VEHICLE ON A PUBLIC HIGHWAY AND H YR MAKE 'MODEL VEH CELL/PAGER PHONE NO. 'WORK PHONE NO. (2061265 -2202 M.P. CITYICOUNTY OF BLOCKS 3300 AUBURNIKING TR 01 LIC NO STATE EXPIRES TR YR 'TR 52 LIC NO 'STYLE STATE 'EXPIRES ITRYR 'COLOR OWNER/COMPANY IF OTHER THAN DRIVER ADDRESS ACCIDENT 'COMMERCIAL LIYE; EHICLE M NO VEH SPEED IN A ZONE 1. VIOLATION/STATUTE CODE AMC6.02.010A.1 'CITY 'STATE ZIP CODE P SS INO IHA2MAT 1 INO VEHICLE HEAR DID THEN AND THERE COMMIT EACH OF THE FOLLOWING OFFENSES 1 ISMD I ACE 1 [AIRCRAFT A LAT LARGE ISTOFFENSE 2. VIOLATION/STATUTE CODE AMC6.02.130.I ANIMAL. INJURE PRIVTIPUBLIC PROPERTY IPENALTYS 50.00 (PENALTY s 250.00 3& VIOLATIONISTATUTE CODE AMC6.04.010 FAILURE TO LICENSE DOG OR CAT 4. VIOLATION/STATUTE CODE AMC6.04.010 FAILURE TO LICENSE DOG OR CAT 5. VIOLATION/STATUTE CODE IPENALTYS 50.00 'PENALTY $ 50.00 !PENALLTY3 ITOTAL PENALTY S 400.00 RELATED IS 1 OF JOTICP: =T SERVED ON VIOLATOR TICKET SENT TO COURT FOR MAILING ▪ TICKET REFERRED TO PROSECUTOR (DATE ISSUED 09 -23-15 I CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT I HAVE ISSUED THIS ON THE DATE AND AT THE LOCATION ABOVE. THAT I HAVE PROBABLE CAUSE TO BELIEVE THE ABOVE NAMED PERSON COMMITTED THE ABOVE OFFENSE(S), AND I AM ENTERING MY AUTHORIZED USER ID AND PASSWORD TO AUTHENTICATE R. OFFICER GEORGE WINNER OFFICER a 9505 a INFRACTION ABSTRACT OF JUDGMENT INF'.# " RESPONSE DISPOSITION PENALTY SUSPENDED SUB- TOTAL FINDINGIJUDGMENT DATE 1 C NC C NC D P DF . $ $ $. 2 C .NC C NC D P :DF $- S $ ABSTRACT MLD TO OLYMPIA 3 C NC C NC 0 P OF ' $. S $ 4 C .NC C NC D P OF $. S 3, TOTAL COSTS S 5 C NC C NC D P DF $ 5 $ PAGE 1 OF 2 2 0 z co N N' 0a Ot' — Q C M-0 Z E3 C 69000 W 2111)I IWOa1SCJ2339 OFFICER REPORT 620720736 VIOLATION DATE T ON OR ABOUT; 923/20115 fo:so-ao A6T Attached and incorporated with APD Case #15- 12326: 0 UI N' 0 V O V W a The information contained in and attached to this citation /notice of infraction is, incorporated by reference into this report. z a* f r*** ****** *************tetere.erewe Officer's Report for Citation/Notice of Infraction # 5Z0720735, 5Z0720736. I CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT ALL STATEMENTS MADE HEREIN ARE TRUE AND ACCURATE AND THAT I AM ENTERING MY AUTHORIZED USER ID AND PASSWORD TO AUTHENTICATE IT. Signature: GEORGE WINNER #: 9505 Date and Place: 9/23/2015 City/Town of Aubum, County of KING TRAFFIC WEATHER STREEr LIGHT WITNESS NAME (LAST. FIRST, M.L) KNOWLES, RICHARD, L PHONE 2639311106 WITNESS NAME (LAST, FIRST, M.I.) PHONE ADDRESS 3421 PIKE ST SE CITY AUBURN STATE ZIP WA 98002 ADDRESS (CITY STATE ZIP WITNESS NAME (LAST. FIRST. M.I.) PHONE WITNESS NAME (LAST, FIRST, M.I.) PHONE ADORFCC CRY STATE [ZIP ADDRESS 13 jCITV STATE ZIP WITNESS NAME (LAST, FIRST, M.L) PHONE WITNESS NAME (LAST, FIRST, MI) PHONE ADDRESS CRY STATE IZIP ADDRESS CITY STATE ZIP WITNESS NAME (LAST, FIRST, NM PHONE WITNESS NAME (LAST, FIRST, MI) PHONE ADDRESS CITY STATE IZIP ADDRESS CITY STATE IIIP PAGE2OF2 680140 1AI 3LLH)1 '1A10 1S02J39 CASE NUMBERS \5r 232L0 OFFICER: VC\MJ( DATE ISSUED: AUBURN POLICE DEPARTMENT ANIMAL CONTROL DIVISION DANGEROUS DOG INSURANCE REQUIREMENT FORM Owner /Keeper of dog: n Last Name: Olt First: -Q J MI: v 1 DO: 5 / \ a ( ( q Address: lei`�f VCt 57 5E City: urin State: VI A Zip: "i 0 UO 2- Home Phone: 2__3(o 'L0 222 Work Phone: Description of dog: j Iny�n � p 4� Name: LIV, `Y Breed(s): l�4AC�1 1/�� Color(s): Q■ Markings: Sex: cYF Altered: aN Age: -6 ,Microchip / Tattoo: U TO INSURANCE /BOND AGENT: The above described animal has been declarer a Dar,! Brous Dog by the Auburn Police Department Animal Control Division per ACC 6.01 and 6.35, Uue to: Per ACC 6.35.020(f)(2) &(3): The owner /keeper of this animal must obtain a surety bond issued by a surety insurer qualified under chapter 48.28 R.C.W.-in a sum not less than $250,000 payable to a person injured by the dog, and a policy of liability insurance issued by an insurer qualified under title 48 R.C.W. ' in an amount nbt Tess than $250,000 insuring the owner or keeper for personal injuries inflicted by the dog. Additionally, written notice must be provided to the City of Auburn Police Department with in 3 0 days of cancellation, reduction of limits, or termination of coverage. Please complete and sign this.. form Department, Animal Control Davis €an, FAX (253) 931 = 5108', Thank Yoh and return with a copy of the policy fo the Auburn Police E ;Ma €n Street, Ste :201, `Auburn, WA 9800 ' (253) 93� 3080 Insurance /Bond Agent: Name: -raSon Address: 1 (I IA/ esf Ail er 1.4K7 1v - 4v6vt , Phone: $S - 6 /5r- 3Y al Company Name: £4e r .,��;nn,l Policy Number: L(L I�1C. -'i'o/ �vj Date: 1o75(_5 Insurance/Bond A Page 6 of 6 DECLARATIONS GOLD STAR HOMEOWNERS POLICY - SPEC #AL DELUXE. FORM (ED 01/06) NON- ASSESSABLE POLICY ISSUED BY AMERICAN FAMILY MUTUAL INSURANCE COMPANY A MEMBER OF THE AMERICAN FAMILY INSURANCE MUTUAL GROUP MADISON, WI PLEASE READ YOUR POLICY POLICY NUMBER 468K- 4901 -01 NAMED INSURED CLORE, KATIE M & WILLIAM E BERGSTROM 1514 33RD ST SE AUBURN WA 98002 -8131 MORTGAGEE REFERENCE NUMBER: 0063349146 CENTRAL LOAN ADMINISTRATION & REPORTING PO BOX 202028 FLORENCE SC 29502 -2028 EFFECTIVE FROM 5/25/2015 TO 5/25/2.016 ACCT 016 -703- 156 -95 COVERAGES AND LIMITS PROVIDED 001 FAMILY FRAME D WELLING IN TOWN CLASS 4 SECTION I LIMITS DWELLING $233,700 PERSONAL PROPERTY ON PREMISES $175,300 PERSONAL PROPERTY OFF PREMISES 100% SUBJECT TO POLICY LIMITATION LOSS OF USE - ACTUAL LOSS SUSTAINED WITHIN 24 MONTHS OF THE LOSS DEDUCTIBLE AMOUNT - ALL PERIL $1,000 SECTION II PERSONAL LIABILITY $500,000 MEDICAL EXPENSE $25,000 ADDITIONAL PROTECTION / ENDORSEMENTS OPTION 1 - EARTHQUAKE - - 15% DEDUCTIBLE OPTION 2 - JEWELRY, WATCHES, FURS, PRECIOUS AND SEMI - PRECIOUS STONES AND GEMS OPTION 14 - COVERAGE B - PERSONAL PROPERTY LIMITED REPLACEMENT COST BACK -UP OF SEWER AND SUMP PUMP OVERFLOW COVERAGE (END 466(L) ED 1/06) $10,000 LIMIT - 1000 DED IDENTITY FRAUD EXPENSE COV (END 511 ED 12/09) MATCHING UNDAMAGED SIDING AND /OR ROOFING COVERAGE (END525 ED 11/09) ADDITIONAL FORMS AND /OR ENDORSEMENTS MAY APPLY THIS POLICY INCLUDES INCREASED BUILDING LIMIT COVERAGE UP TO 120% OF THE DWELLING LIMIT SHOWN ABOVE, SUBJECT TO POLICY PROVISIONS TOTAL PREMIUM $1,226.00 LOCATION OF RISK: 1514 33RD ST SE AUBURN WA 98002 -8131 Declarations effective on the date shown above. These declarations form a part of this policy and replace all other declarations which may have been issued previously for this policy. If this declarations is accompanied by a new policy, the policy replaces any which may have been issued before with the same policy number. AUTHORIZED REPRESENTATIVE President AGENT 038 -359 PHONE (253) 631 -3481 Secretary Jason Grill USERID HXA017 1002 15TH ST SW SUITE #100 ENTRY DATE 10/05/2015 12:00 PM AUBURN WA 98001 SIS ID 63312322 Form No HO -47C Ed. 6115 1 of 1 Stock No 23281