CITY OF RIALTO CITY CLERK'S DATE STAMP
LIABILITY
CITY OF RIALTO
CLAIM FOR DAMAGES
TO PERSON OR PROPERTY 2024 SEP 24 PM |: 21
RECEIVEL
1. Claims for death, injury to person, or to personal property must be filed not later than six (6) months afler the occurrence (Gov. Code $911.2) CITY CLERK
2. Claims for damages to real property must be filed not later than one (1) year after the occurrence (Gov. Code §911.2). RETURN TO:
3. READ ENTIRE CLAIM FOR BEFORE FILING
4. ATTACH SEPARATE SHEETS, IF NECESSARY, TO GIVE FULL DETAILS Rialto City Clerk's Office Mail: 150 S. Palm Ave., Rialto, CA 92376
Address: 290 W. Rialto Ave., Rialto, CA 92376
CLAIMANT INFORMATION: * Tif Fan; Mays 04-05-2000)
margaret Newton
FULL NAME DATE OF BIRTH
HOME ADDRESS INCLUDING CITY, STATE & ZIP HOME TELEPHONE NO.
NA
BUSINESS ADDRESS INCLUDING CITY, STATE & ZIP BUSINESS TELEPHONE NO.
ADDRESS AT WHICH CLAIMANT DESIRES TO RECEIVE Same as above
NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
(if different from home address provided above):
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: 07-30-2024 _TIME: ДАМ ДРМ
2. PLACE OF ACCIDENT (OCCURRENCE) BE SPECIFIC - Describe fully and (if applicable) locate on diagram on reverse side of this sheet.
Where appropriate, give street names and addresses, measurements and landmarks. paster bedom disr
all way bedroom door
3. HOW DID DAMAGE OR INJURY OCCUR?
RialtA-SWAT Team (Rialto Police Dept
4. WERE POLICE AT THE SCENE? DO VES DINO WERE PARAMEDICS AT THE SCENE? LOVES O NO
5. WHAT PARTICULAR ACT OR OMISSION DO YOU CLAIM CAUSED THE INJURY OR DAMAGES? Give the name of the city/town employee causing the injury or damage, if known.
for Kevin Mconico
house and broke
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $450,00 HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE:
Item/Date: Master bedron dir Amount $ 450.00
Item/Date: sarum Left of hallay Amount: $
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: = 450.0 ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:
Item/Date:
Amount: $_
Item/Date:
Amount: $.
TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: $
7. WITNESSES TO DAMAGE OR INJURY List all persons known to have information (attach additional pages, if necessary) NAME: NoSeph Bright NAME: TIFfARi MaNs
ADDRESS: ADDRESS:
TELEPHONE: |) TELEPHONE: L
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITAL(S) VISITED:
NAME:
NAME:
ADDRESS: ADDRESS:
TELEPHONE: L TELEPHONE: L
DATE: TIME: ДАМ PM
DATE: TIME:
9. PLEASE READ THE FOLLOWING CAREFULLY:
For all vehicle accident claims, place on the following diagram, the names of streets, including NORTH, EAST, SOUTH AND WEST directions. Indicate place of accident by "X and by showing house numbers or distances to street comers.
If a citytown vehicle was involved, designate by letter "A" location of the City/Town vehicle when you first saw it, and by "B" location of yourself or your vehicle ace euby actre point oh impact alon of Ciy Town vehicle at time of accien by A "A-1" and ocation of yoursef or your vehicle at the time of the → NOTE: IF THE DIAGRAM BELOW DOES NOT FIT THE SITUATION, PLEASE ATTACH A PROPER DIAGRAM SIGNED BY THE CLAIMANT.
CURB
PARKWAY
7 SIDEWALK
HAVE READ THE FOREGOING CLAIM AND KNOW THE CONTENTS THEREOF; AND CERTIFY THAT THE SAME IS TRUE OF MY OWN KNOWLEDGE EXCEPT AS T HOSE MATTERS WHICH ARE HEREIN STATED UPON MY INFORMATION AND BELIEF; AND AS TO THOSE MATTERS I BELIEVE THEM TO BE TRU I CERTIFY (OR DECLARE) UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
SIGNATURE OF ELANDANT OR AGENT
Newton Eiffani mays 09-24-24
YPE OR PRINT NAM
DATE
Self
RELATIONSHIP TO CLAIMANT
NOTE: PRESENTATION OF A FALSE CLAIM IS A FELONY (CA PENAL CODE 72) RETURN CLAIM TO: RIALTO CITY CLERK'S OFFICE - 150 S. PALM AVE., RIALTO, CA 92376
INCIDENT REPORT
Agency Name: ORI# Report Date/Time: OCA#
RIALTO POLICE DEPARTMENT CA0360900 07/30/2024 17 19:16 932408074 Incident Start Date/Time: DOW: Report Type: Case Screening: CHP 180 07/30/2024 13:12:44 Tuesday INITIAL Total Loss
Г Serialized Property Hate Crime
Incident End Date/Time: Internal Incident Status:
• Evidence Collected • Gang Related $0.00
07/30/2024 17:19:19 Г PC 293 Sex Crime • Domestic Viol. incident Location: Secondary Location:
Case Description: UCR Status: All Other Reporting Area:
AXON, PHOTOGRAPHS RI054
Operation Method:
Penal Code: UCR Code: F/M: Penal Code Description: Counts: • Comp/Att:
245 (A)(1) PC 04 3 FORCE OR ADW NOT FIREARM: GBI LIKELY 11 Ш Structure Bias Motivation: Offense Location:
RESIDENCE / HOME
Weapon Used: Situation Code: Premise:
SINGLE VICTIM / SINGLE OFFENDER RESIDENCE (ANYWHERE ON
Penal Code: Pena! Code Description:
Counts: Complat:
242 PC BATTERY/WITH INJURY
Structure Bias Motivation: Offense Location:
RESIDENCE / HOME
Weapon Used: Situation Code: Premise:
SINGLE VICTIM / SINGLE OFFENDER RESIDENCE (ANYWHERE ON
| Person Name: Phone: Cell Phone:
Business TIFFANI LEONDRA MAYS 909-205-2462
Address (Street, Apt., City, State, Zip): Pager:
Involvement Type (Person): Victim Type (Business): Domestic F LEOKA Activity: LEOKA Assignment:
VICTIM Violence
Occupation: Employer: Employer Address Employer Phone:
1O UNKNOWN OR NOT
> STATED
Relationship to Offender (Person): DOB: Age: Sex: Height. | Weight. Res y Type! Minor Injuries Unconscious
Other Family 124 F 501 165
Internal Injuries F Teeth Injury
Race: | Ethnicity: SSN: License (#, Class, State): Related Offense(s):
Lacerations Bone Injury
Black NON- U CA 04 04a. 26 • Other Injuries
HISPANIC Y8948150 None
Suspect #1 Name Phone Cell Phone: Pager:
KEVIN MONTRAY MCCONICO
Address (Street, Apt., City, State, Zip): Occupation: Employer:
10 UNKNOWN OR NOT STATED
Suspect Forced Victim. Primary Action: Employer Address: Employer Phone:
Solicited/Offered: Suspect Force DOB: Age: Sex: Height. Weight: Build: Complexion: Eve Color:
47 M
Race: Ethnicity: SSN: License (# Class State): Related Offense(s): Hair Color: Hair Length: Hair Style:
Black NON-HISPANIC CA 04 04a. 26
Clothing Description. NCIC #: State ID #: Facial Hair
Speech: Teeth:
Body Markings (Type, Location, Description): Suspect F Suspect Additional Additional v Injured: Arrested: Suspects: Persons.
ALDAMA. JOSEPH 02193 07/30/2024 17:31.45
Z Reporting Officer ID# Date Reporting Officer Sighature CONT
CONFIDENT TIAL COPY
DMI Assisting Officer Signature C 11142-11143
Assisting Officer ID # Date
NOT FOR THIRD PARTY RELEASE
SCALF, RORY 01374 07/30/2024 20:53:44 Reviewing Officer Sighature LICE DEPARTMENI Reviewing Officer ID # Date TAV MAS
BY Jum. Paget of ?
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M&B
HANDYMAN CONSTRUCTION SERVICES
Mark Hart
Rialto, California 92376
United States
Mobile:
[email protected]
Invoice Number: 38
Amount Due: $450.00
Payment Due: September 20, 2024
Bill To: Customer
ITEMS AND SERVICES AMOUNT
Replace ceiling trap door
and 2 bedroom doors $450.00 V
1 x $450.00
Total (USD): $450.00
909-952-1428
inteior door is only $315.50
tOr
Ine ceiling trywa is only 186.50
It we can't we wont tandy man
serrices
(833) 641-8635
404-401 9668
0003y-000 handyman. work
904) 'n -9668
$ 240 new door repair
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Popi
76 fuzzo? 1502 =2-854