. Agency cm
COUNTY 20177002310
REPORT 51141 a- 14111 :1 
NC 0110000 2017 17:40 
mam 1' 'r 3 Knuun Serum 1' 'r 
141 Month Day 1' 1 Munth Day y. Tune
1' Maul/00 Female Di '7 03 1 12 1 20171 17.401 03 12 1 20171 17401 
"2 mum" Tran
A 65 L'henrmr Hill 12.1, 11101-1. Mann/1.1.. NC 2871] 13:31)
1' "3 
A Co 3 
Haw Anackzd anhk Wupon/ka
MO LHul/Hrhl Dunn, 15mm (If M. 111.00.. Pmmum. LHul/Hu During A11 Eff MA Pm..m.1 meum (Mmd'. Fm
mem Tux I-unry DLuSsulTeeLh Dms/Almhal US:
Some!) Bung; 5mm hum," E, '15 
I LE Olficer .71 Dmy Omn/L'nknuwn "mm. No 
I VIChm/BunnusNam: L1H rm. M.de D1 Run 59. Rtlallummp Renews-mm
Cum: 11 Tu Ollender 
V1 DNmI-Reslden
'1 Unknown
Hum: Hum: 
05 CHESTNUT HILL RD. 1311.11. Mnmuum. NE 287]] 
mm. 
VYR 'Mm lubed 5mg VIN
cons v21 0 umnn K:R?pm1mg l'mm'm umnn
Type :1 1:1 Busing" 1:1 50cm :1 1:1 1:1 mam." 1:1 meereuIDul 1:1 Olhzr/Unknumn
0 m. 1m. an. 11.1.1111 a: Ra: 52x
1' .1



Emplayu Nun/Address Mabll: 
1
Type :1 El :1 Sunny meuml EIL a om./u..knum.
m. 1m. an. Mmle .7: 52x
0 .1

mm Ham: 
Add;

Emplayu Nun/Address Mabll: 
szvuzd Damaged 5mm 5 mm F: Faund
cmu 10mm "or culunm Ilmcmemd 
v.5 
on 01 on Prupeny Mala/Msz Senal Number
9





1'

17 0
1m 5.. nlwer-nanue
u) LYIWARD. 11. E. 313:; (81707) EMPEK R. L, (517111 9151130515)
Signmm: 
Invzulgallun L'nluundzd mm mum
sum 1mm: Eclemd by 
Cleaned by try 
- CIuwd/kadsExhauued . . mum Pa 3 1

 

 

bureau; Rev 2/92