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CENTERVILLE-OSTERVILLE-MAItSTONS MILLS FIRE REPORT ALARM:
INCIDENT LOCATION '�'f rN /��
TYPE OF CALL:
c 14REPORTED BY: .•
' TELEPHONE: ADDRESS: w,
' AT .SCENE: -
.. ZDZS D.O.B. :. TELE Cc
DATE/TIME- OF INCIDENT: MO:/0 DAY: YEAR: DAY OF WEEK TLeS 'TIME:
DATE/TIME OF INVESTIGATION: /p-%/-f DISPATCHER: Y14 xF
STILL: ALARM: HOW REPORTED: PHONE.: Z IO: OTHER:
VILLAGE: CENT x OST MILLS OTHER WEATHER:_I�WI—ND
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TIME OF CALL: � ARRIVAL: �n7 g CLEAR: �c`j >O
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BUILDING FIRE: TYPE OF CONSTRUCTION: DIMENSIONS:
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OWNER: D.O.B.
ADDRESS: TEL#:
,x TENANT: D.O.B.< ADDRESS•' TEL#:
EQUIPMENT: YEAR: MAKE: MODEL: SERIAL#: r,
VEHICLE FIRE: YEAR: MAKE: MODEL:
STYLE: REG.#: COLOR: VIN:
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� t BRUSH/GRASS FIRE: AREA/SIZE: X CLASS: COST: •
INVESTIGATIONS, OTHER OUTSIDE FIRES, MISC. , EXPLAIN:
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DAMAGE: n L pN il+�z Cl.Cuyec,>G� Q►•
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REPORT* BY: CHIEF: /b fl�D� DATE.
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