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EFTA01651057
O Spouse O Child O Legal Guardian O Attorney 3 Tell us about the crime. (Check only one.) The victim died because of: ID Motor Vehicle (DUI/DWI) K Motor Vehicle (Other) O Terrorism O Arson K Human Trafficking O Other I {mikado County O Other (Explain): ._. The victim was injured because of: K Assault
EFTA01712677
- -11)1 a y EFTA01712775 Raoul Request FD-123 (Rev. 4-141) Dam 0 (0/0 ♦ 020 0 7 K Birth K Credit KCriminal K Death K INS K Marriage• K Motor Vehicle K Other To iSS Buded Return to R kA-Aat rLotAk&o.\\ E , Name and alit cs ofsubject, applimm, or employee, and spouse Address Residence Bus
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