NUMBER 05 - 3 (,g, DATE/MIE RFCOVERED 12 IS lacy ,-- PROPERTY NUMBER Mon Merle BIN NUMBER (Lowe Meng ADDRESS WHERE PROPERTY IMPOUNDED 40% t.)• D\XIE lAvvy \ae) DISCOVERED BY/0.0.8. ADDRESS Surat Cary an PHONE Kamen WIRERS D.O.B. . , O Ve4ALY EAU-% k--V-..)- ADDRESS are lote0 OIcitt‘Atac.• 75