q Offender/DOf V 4p icr--t-e--0 (Officer's Signature/D ) o r \ cietz tasn-fr Home Addre41Directnfokciliaria: 1" C.A, erig TelephonelTele. de Cara. Cell Ph!Tele. Cession Employer/Patrono: C'Sr - Work Address/Direcci6n del Trabajo- 264 A, arnia, fit illY Work phone/Tele. del Trabajo#: Pager