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i <br /> BURN OR INIURY (Civilian) (Firen ^� ,:qH ❑ ptii�� ] � <br /> NAME AGE SE% w1UiY C Pllpl. MOSt.;] <br /> DESC0If10N Of <br /> 9UM OR M1U�1' <br /> oEGREf 01 WIN � In Q 7nd ❑ l.d °/p O7 l001' IURNlD <br /> INFORMATION FOR ALARM OFFICE <br /> 1. Address and phone where occupant can be contacted, <br /> Addre�+ Phone <br /> 2 . Estimate of Building loss $ <br /> Insurance Agency <br /> 3, Estimate of Contents loss S <br /> In.^,urance Agency <br /> RENARKS <br /> Number of �prinkler heada that opened _ <br /> .4r. ;�Ieyer� doing remodeling work, cras burn_ng debris in fl.replace. Spark ignite3 �rood <br /> shingles causiug small fire. <br /> Aerial �1 laddered building and extingui.shed £ire with pre-connect from �'no ne ,%2. <br /> Roo� patched with visqueen. <br />