11329 2ND AVE SE 2024-11-07 - Laserfiche WebLink

• ! 410Incident # 2019-00003838 A I 31M04I I WA I 103 1102 12019 I ( II 00035741 1000 Delete NFIRS-IS I Supplemental F010 * State* Incident Date Station Incident Number Exposure ! Dc enge ti * Ki Person/Entity Involved I I I —I I—I I Lowi a Business Name(if applicable) Area Code Phone Number lOptiCheck this box if a same address as Mr.,Ms.,Mrs. First Name MI Last Name Suffix incident location. Then skip these three duplicate address I I I I I I I I L__I lines. Number Prefix Street or Highway Street Type Suffix I II I I Post Office Box Apt.lSuiteJRoom City I I I I — I I State ZIP Code KPerson/Entity Involved I I I I-L_I-I 1 1 Lan Business Name(if applicable) Area Code Phone Number 0Chec k this box if I I I I L_J I I I I same address as Mr.,Ms.,Mrs. First Name MI Last Name Suffix incident location. 11 '' I Then skip these these duplicate I I II I I I I II address lines. Number Prefix Street or Highway Street Type Suffix Post Office Box II I I Apt.lSuitelRoom City LJ L-J — I I State ZIP Code Person/Entity Involved I I I I-L_�-I Ki Local Business Name(if applicable) Area Code Phone Number DChec k this box if I J I I Li I I I I same address as Mr.,Ms,Mrs. First Name MI Last Name Suffix incident location. duce"skipo a threethese I I I I I I I I LI lines. Number Prefer Street or Highway Street Type Suffer I II I I I Post Office Box Apt/Suite/Room City LJ II — I I State ZIP Code —. Person/Entity Involved I I I I—I —I I ` Ki Local Option Business Name(if applicable) Area Code Phone Number 0Check this box if I I I I L_I I I I I same address as Mr.,Ms.,Mrs. First Name MI Last Name Suffix incident location, duplicate addressen skip � I I II I I I I I— I lines. Number Prefix Street or Highway Street Type Stdfix I II I I I Post Office Box Apt/SudelRoam City L__I I I - I I State ZIP Code Person/Entity Involved I I I I-I -I I i Ki Business Name(if applicable) Area Code Phone Number Local Option Check this box if I I I I IJ I I I I same address as Mr.,Ms.,Mrs. First Name MI Last Name Sulfa incident location. duplicate skip sroe I I l_I I I I I LI lines. Number Prefix Street or Highway Street Type SuNx I II I I I Post Office Box Apt.ISuitefRoom City I—I I I — I I State ZIP Code Lk lq Printed 13:09 03/04/2019