4 V ctim Information ;;mo locirooloontileci Date O O Ing 0 DeCeased - Ir Rosett by. G Terren: 2 Dille bunter of HOSta9aS. Dismanenent Date: Gomplatan of Ft3.515a S.cis 2 itandatory Nurrhar 31E-mm-105"06z Sta: A.Rfiril Soc Sec NO ( C-e• •••••••,. (Name: Investivativ• Assistent* or Technique U