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- . — -,- _ __ dy � _ ` � ` <br /> ' �... i � -� . <br /> i SNOHUMISH HEALTH DISTR�CT <br /> Court !-lause <br /> � Everelt, �",'ashingfon <br /> I <br /> ,' COMPLAINT SHEET <br /> The following musf be compteled fn full . Dafe 3_.�j.(.�9 <br /> i - <br /> Name of Person causing � <br /> alleged complaint �j,7�j��?T � �`,�,�7 �n <br /> Address or direefions ! ? �����rNi�> ��,iY ��� _ /� � <br /> ��.1 �i� S.� �� <br /> Nature of alleged complaint l f+= �/�'L��. �//'�n �,j�'J/ Tc � <br /> h� � /'/7D/�� r9� <br /> �!�/>'(�/�n�n "/."!.� /','l.'i'rl TL ,U�i�l+ci� n;,•.., �y� /�/�'�/'I rr-�r+- <br /> 'cLn SFi'mc ;. � t�r_- „ �i.,�� — <br /> ` �inv�i�/L' n � � � ��yF <br /> -�t=1��f-R i,, nTF� �� n�'�.'/!c%v'� OriT nF niia � j� c <br /> vA�n rai� ,n�� <br /> �/ii�l! `:✓?�F%/ .¢ c�n?_o.,.,,.�. - i�'/�J� C�/lil/> <br /> , <br /> �lame of Person Reporting (Pleose sign) • t• � <br /> ..�' n; <br /> Address— ������ ��I-y,�,�s �i �7 � �' <br /> i // . �y �"�� � Phone 2�:7 5 '�__ <br /> �R*����Rff}RRf fRfM}� } � �A H }/ fd1R1} ♦*��RR►*fR♦ •f�fA�• 1f��tbff�tAM/11�' I <br /> DO NUT N.�RITE BELGH' THIS LINE � <br /> ♦1tkR*tR*�f�fRR►RRfR��*RlRfR��Rlrf�fffRRlRfM*��A*R*!A}fkRf��Af�tff�fffR�f*R�R\RfRtRf . <br /> Investigated by � / <br /> �� i r" Oafe .�Z� <br /> Conditiom found {�h„_ / •� � • �7 � . � <br /> I �i.�- 1 � <br /> � <br /> Perwn (s) contacfed �, ' ' <br /> ��� %� � <br /> � <br /> Acfion tak — <br /> ,� <br /> - I <br /> �'�, �,/ ov,, <br /> d <br /> � <br /> 5168 <br />