c,.. :. •.: "?.,..: ' • • "': . s ' ADDRESS .. , . . ' . . ' 's• • • • '•• PHONE NUMBER . ez: • • . .. . - • • . . . . . : CLARA 0 • • : .40 DAYS. % ' . Nor ciAssia mai' -QUANTITY .VALUE. ' -CI. .....` • '`?" af•''• GRPTION . 1.4- • • -• • - • • ron.4.. nk_ ni.idif

ty Zip PHONE NUMBER Aoorm.. SUSPECT / D.O.S. ADDRESS Street City Zip PHONE NUMBER SPECIAL NSTRUCTIONS FOUND PROPERTY CLAIM K 90 DAYS NOT CLARA 0 ITEM a QUANTITY VALUE DESCRIPTION TOTAL PACKAGE WEIGHT I hereby acknowledge that the above list represents all property taken from me and that

Staff CfAo a 3% 61 Eathic LAI:, PhiA Getil4 Ft 3;44.e) (50 UK ADDTNL. SUSPECT/ D.O.& ... ADORE Ad 06 FL 339I PHONE NUMBER FOUND PROPERTY CLARA 0 SO DAYS NOT CLAIM 0 ITEM I OUANTITY VALUE DESCRIPTION e I I 1 ;Melt TAPE — &cl.lje4 644;0A C1ItERIDS- TOTAL PACKAGE WEIGHT I hereby ackn