IDENDCITATION NUMBER b5- 503 DATE/TIME RECOVERED lo-11-05 (goo PROPERTY NUMBER (Leave Blank) r: (r) - i 0 D -S. BIN NUMBER (Leave Blark) ‘ ..:_c/ Li t'j "•-• ADMVERESOPER IMPOUNDED Anlit 2 0,O 0 COVER D /0.0.B. ADDRESS 19 Ca), ZIP PHONE NUMBER • - OWNER'S NAME i D.O.B. ADDRESS Stt