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THERAPIST Fema • 0 e Employer? . Oper Lic No Race Height • 0 Person Type • • • . : • White ***EMPLOYER INFORMATION*** 1-05-000368 PBC DIVISON OF YOUTH AFFAIRS 4200 N' AUSTRALIAN AV WEST PALM BEACH, FL 33407 E R P E R 1-05-000368 WAIMMIOW 16 STUDENT 4MOMNIIIIMM Male 0 (Continued) . : O

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: FAMILY THERAPIST Oper Lic No. . : Race White Female Height 0 0 Person Type . : OTHER PERSON ***EMPLOYER INFORMATION*** 1-05-000368 PBC DIVISON OF YOUTH AFFAIRS 4200 N AUSTRALIAN AV WEST PALM BEACH, FL 33407 *********OTHER PERSO Case Number . : 1-05-000368 Street Number City Birth Date/Age :

0 Female 0 ADULT VICTIM Case Number . : 1-05-000368 Street Number : City H, FL 000033480 Birth Date/Age : 16 • Employer? Employer? . Oper Lic No. Race Height Misc. ID# . . : Other Phone Nbr: Residency Type : File Charges . : Victim Sobriety: Injury Type 1 : Hospital ID . : Phys Firs

/000-0000 Race • White Female Height • 0 0 Person Type . : OTHER PERSON 561/000-0000 (Continued) ***EMPLOYER INFORMATION*** 1-05-000368 PBC DIVISON OF YOUTH AFFAIRS 4200 N AUSTRALIAN AV ACH, FL 33407 E R PERS NI FL 6 Male 0 Case Number . : 1-05- Address . . . : 4900 City/State/Zip : WEST Phone

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ON Other Phone Nbr: Case Number . : Employer Name : Address . . . : City/State/Zip : Phone Number . : ***EMPLOYER INFORMATION*** 1-05-000368 PBC DIVISON OF YOUTH AFFAIRS 4200 N AUSTRALIAN AV WEST PALM BEACH, FL 33407 ********* OTHER P E R S O N INFORMATION Iiiiiii ********* Case Number . : 1-05-000368 L