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EVERETT POLICE DEPARTMENT STATEMENT FORM <br /> CASE# DD ` JcC4 j <br /> STATEMENT OF: 1111.? LAST NAVE H R fRRST PLANE E NAME <br /> C.AuC, 68 28- i -i0# I3 Luc <br /> RACE SEX DATE OF i3RTH NEIi11T WEIGHT EYE COLOR NAIR COLOR <br /> RESIDENCE: 2 1001 ST �J D-Z U� E I2�1 N./VA 4182-0'i <br /> STRE$r ADDRESS CITY STATE ZIP <br /> HOME PHONE#:C`-125 -2A0-1/92,8 WORKICELL#: N 1A- EMPLOYMENT:ht Eva T CLI N <br /> ALTERNATE CONTACT(IN CASE OF RELOCATION): <br /> LARISTJNE RARPER AM FILING ,)JClp i 2E1�o1T F-DR. A <br /> PF:ev1OU5LyFIL L'S FIAL Sz 'o ZV -- A GRite- D 13 -846 3 Ft Le-D ON <br /> ( AR? iiUi1Jh I 4 12ESIDE,QT AT RiqoPt.DLOPI-Y CoNitomiN►Urt)) 215 <br /> 00 9c Still It.' Ev eRC T a Ilk. MT gcs►)Es )7.1 U J:-; )-=30L1 . I AND M <br /> NUS16A,4D ) WILLIC RtstDC IN D-205 y 07\e- Fwo1 1 Et,oW AND OIJ <br /> Tt, 14-E R SIDE o THE 3LiIL1D,NU_ ON -THfT DAT& j- eo <br /> C© Ns <br /> I-05SociftTion7 IAAS CON IDT-Ir1 FIRL ALARM H,.iD CNt/4j'4& ' i>.is?EST ioNS <br /> �- <br /> vQ-A Tyr& REPRCSEN P T Ive Accort*WiNG) 'fl- FIRE-,4LARM CO <br /> OND B0(4t2JJL1E LILLI'\A,J tr t A-GcomPAWL0C4 ci-kirWEY <br /> C0N T(PCT OR. CNHMi.S A-ND CoNTAOT INFO FOR BCY - AT IND of 11±15 R oa7)., <br /> WE- ARfZtvED A-T A-6ouY hE SAM& T itAS - APPZOx019TL Y <br /> i • 00 A-M . MR- RusG,ELL, WAs El-TA-6z. IN OvR u/N1 c l tri l-f"►NJG -r <br /> )N G?Er..TI;RS i oft GT I-No1 N 6 ) N DUR 2N0 FLOOR IAA Li__14) Y vok-i C rl i N 6.) i i =-- <br /> PgoL%-E'L1ii\lL AN* Ai )PE siNN AN`f 1SsU[-S WE- 11i-Vf t-kRvc HAD . /is, wa <br /> 1-1tri lkt IN T is M LDDL , r} LLLUPry) WILLIE I-Lr <br /> OUR VN(T L=XITES? DoWiJ Tr1t= GAAST �T"t'�tfL I✓L - AuD WPrL\ AR 0UND <br /> TlkC. ) SC RTH ENO o F THE %tj I Lt)I iJ is E ROUT D-n-tE CA-Ar} b AT No Ti I-tL <br /> 19 A-tN? OF US SEE MR. IUSSCLL_ R'N0A61* - 1'lu'>✓t1- k AgraVSs hit-) <br /> • <br /> THIS STATEMENT WAS WRITTEN ON MY BEHALF BY: <br /> I DECLARE UNDER THE PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE <br /> FOREGOING WRITTEN STATEMENT, CONSISTING OF PAGES, IS TRUTHFUL AND ACCURATE TO THE <br /> BEST OF MY PERSONAL KNOWLEDGE. EACH PAGE AND ALL CORRECTIONS, IF ANY, BEAR MY INITIALS. <br /> I HAVE READ [ J I HAVE BEEN READ[ J THE FOREGOING DECLARATION AND UNDERSTAND THAT THIS <br /> DOCUMENT MAY BE USED IN A COURT OF LAW.( ) <br /> (DECLARANT SIGNATURE) (OFFICER OR WITNESS SIGNATURE) <br /> (CITY AND STATE WHERE SIGNED) (DATE OF STATEMENT) <br /> Page of °NIT.) <br /> Pu-004 Ser 7/Z007 <br />