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Fe_rs,sitat v-th-Lca (41-0 -164 1,4,4aate/WAA •l titc“,c_w_ ot?e_ft upt•-t. 102.4-t -tDc.D.e_s-cts 4tut. C-(44/14- 6" AcedreSS • (,,3 ( 1-&- art /fro kz_d ' C6X-A)P6Z.Ac--e_ OA OZ,OZWO tfi_d c>r- echert jex9k- Ad-ie AAd (badtn ,i (. 9te•-te -,S42- 1(10"- ACTION TAKEN: 11041- 4-d Ca71.4."- C..f• REPORT COMPLETED BY: SCALil Dr - DATE: 03//3 / (0 REVIEWED / HANDLED BY: TITLE: CLIENT CONTACTED: 0 BY PHONE 0 IN PERSON TICKLE / FOLLOWUP DATE: CLAIM POTENTIAL COPY TO HQ'S YES 0 YES 0 NO 0 NO 0 (MUST BE SIGNED ON REVERSE) .4 3 W.14 PR (11/06) Copies To: Area Office Copy to: HO'S EFTA01157907 COMMUNITY INCIDENT REPORT COMMUNITY INCIDENT REPORT - CONTINUATION FORM COMMUNITY A ct..) TWC CASE 11 NARRATIVE .-- 4.".L.S In.e.-d /cacti./ c A.r.k( 1-,e_ar a.4 Adz) v-ect--.../4-t Oad-e.A1,,ok-- 4,e4),,c1-&40. `W'S r-- r•xacr-L..a.-L r.4-V.-e-0( are.2a. OAS T varil-a, e• -pi--- -iee..SS. Ta_ixt Be.a_ej, R )/ect , l 71e1721-44141-4/1</- 4-CraMci. --7-6-e- ( /WM. 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"RA Bezck- et- -s --sc-Lbc, CC' REPORTED BY: SctxAL DATE / TIME OF INCIDENT: 7 iws-s (PRINT OR TYPE NAME) 1,c • INCIDENT: 04 IRREGULARITY L CLIENT COMPLIANT 0 FIRE REPORT UST PERSONS(S) INVOLVED: DETAILS: Oft GS S CL° 24- 1.-VIS 1"msrs ( a L.lac-V- ikAs-x-citcru-s 6t94#-- RiDracx -has (fS.GI \I'M droVe-- c,)? auzivt--ts resat-eNce- "IQ- tdas-ck(-e.n.L..) 4,2.-C%-kt-e-e_ •-ez.rt,#4,42 A,e44-- 4D 0 cADTA Can-t-cr .vakes . t-cAc/A.1 eask.604. F --fie: gerco_creer z- ski) So 142- Xr(sf.er 'Sat < -O",4- eptAcGx.n ,frttgrs S- -ereM" u-%,140:"- 024 2-tAt,,44— Ite_ &A.4" eigA-ra-tnea. Z c,D(1.4. (c- ( 6)-(--C.. O-c t„*.e.,...t_ t,942.re_ tke.- 2-ei>0. 16C,„ t_a ACTION TAKEN: REPORT COMPLETED BY: S.c.4-extor- DATE: -V.S710 REVIEWED / HANDLED BY: TITLE: CLIENT CONTACTED: 0 BY PHONE El IN PERSON TICKLE / FOLLOWUP DATE: CLAIM POTENTIAL YES 0 0 0 COPY TO HO'S YES 0 0 •. 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