M Cid JIM ADDRESS 9 65,0 Crty 4 PHONE NUMBER ADDRESS sifter City 4 PHONE NUMBER SUSPECTS NAME / 0 02 a\lri Pi i L. I --doe3 ADDRESS Sueet C,Iy Zip PHONE NUMBER ADDTaIL SUSPECT / D.0.8 ADDRESS Street Ciat Z0 PHONE NUMBER SPECIAL INSTRUCTIONS FOUND PROPERTY CLAM LI 90 DAYS N

3 4942O57 4,719.OO Transit • ini ann. - crimp Ten•-• ___Lt Fifth Third Bank 065082 Insurance Office of Central Ohio EceRVAX}Et:P 165 W Man Sueet P.O. Box 780 2S 21C1440 Now Albany. Ohio 43054.0780 Reteienco 21281 Ch*dc Ode 0210512013 PAY TO THE LSJ, LLC ' ORDER OF S 4,719.00 FOUR T