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�' ' CIT1 OF ErE1tFiT FI�E /RE7ExTlp1 6tn�fJW lj t-�R�s He2P /Vv� �
<br /> ri� tN,rEmana �
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<br /> �. inclEent No. tb276 S, to11c� Erent Mo, oo�7iy �,,,_GJ
<br /> 6 � �d
<br /> . Octupi�t � w«e .� �..�#� 1. AQQress 4 yy,�i�'�.,,,,/eu:B..«'r 1 '�P^9'��
<br /> d. Ptton� -- 9. Qusinest PAon� S�z-3.�zo 10.�Yb�ploy��. F�.e4a.��',&�,
<br /> 11:�. Qrn�r� R�,�o.s F.�a,aa:i 12. /�one • SzS-o763 �
<br /> 1�. Adane:t _(0007"k°a.�.r+a iv.E. ..saa�''u.�i':" 98%/s""'
<br /> 1!, la�tion of InttOent yy�� � oB ' - �„a.a�JuJ�,,,� ,8zoy
<br /> . 15. Foint of Origln - a,�a,.
<br /> 16. Initt�l Materl�l Ignitee
<br /> 17. Sourte ot J9nition
<br /> 18. Premises Locked _ .,,.,�. 19, ForciDle Entry �,.
<br /> 20. J�cttrtties of last Person on Premises u,,,�„e•w� ,,�—�,.�,�,,:e
<br /> 21 . Dessriptton Dy Person Discoveriny ftre ��.,,�„e.,,,,��,„���,d.�,��
<br /> ��/y/ �01�1Ce-..a�'..:. .�., Totpn ,2esf�wu/�t,vf Zs�- 3�77 S�i10 z� a�,ott
<br /> /`� 'r� � � T.�vw�r N�SN�P '�JG4f'W�'�f(!' ' ��.)
<br /> 22. Factors Inftuencing Ftre SpreaE �
<br /> 23. Qirection fo He�t Travel ' � '•
<br /> � r�.,�,E
<br /> 24. Fuel tonsumptton ' ' •,�,�,
<br /> 25, th�r Pattern ,,,,,,,,,�,,,,,,,�� '
<br /> 26. Glass Coloratton _ N�A
<br /> 2I. iloor Coveriny f� , . � . �/
<br /> _ 28. Evidence Reaared � .$„Q ,,..aX`�„ � �,e,Z:r�..,�,.;,, I
<br /> 29. T�99ed Dy `a_ �a�a,,._ 30. Dtspositton 31 . F�otos Dy „ ,,
<br /> 32. Estt�neted Ttae Burncd Defore Dtstovery / ,�.,;,,,.,�
<br /> 33. Af ter 1D ,,,,,,;,,,ti,� 31. Teeper�ture
<br /> 35, proDaDle kt or Oaissioaetela.�a.�� ng P�..�v,C..,�nrestig�tor's Conclusionl .9r«a
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<br /> �� .�,��1'4 v�GS .« o�>-i�-g9 � �.:�.�..��.rao..� �a �.e�e�as•e 'a,�„
<br /> �'1 ad ?7 i t -�s� �.�,
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<br /> ` `�Ey .� � Aos76 a-. a�-�z-qa a,u.-,. (. ?� �.ur,.Q�A�.,.
<br /> BUILDINGS CONTEMTS OTHER
<br /> YALUE S f f � ,/,,, yo
<br /> IHSURANCE _ = Z
<br /> ESTIMATE LOSS = = s
<br /> AIUUSTER Z s � Z
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