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<br />r 1/(1:. LU;:);:) I<t.l"" JI(J
<br />. aATE FIRE I~ARSltAL
<br />F~E PREVENTION .SECTION
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<br />IE .OF
<br />.ai-l B : 7 3 pm " DATE 7 7 /2 2/ B 9 1 9 .
<br />:ATIOil_ 7'1914 NOJr.:th Avenue L
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<br />CITY. OR COUNTY La POJr.:te
<br />La POJr.:te.
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<br />.:::.~ ~,..
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<br />I TEXAS
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<br />:U P ft.;:C'/
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<br />Re4.i.de.nc.e.
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<br />TEXAS' .',.
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<br />COtISTRUCTION Wood 6Jr.ame..
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<br />U?AIIT
<br />
<br />Vanny R. tllh.i.:te.
<br />
<br />NUI.mER OF PERSONS HADE HOl-lELESS
<br />ADDRESS M.i.llwauh..ee., W.i..6 c.o n4.i.~
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<br />4
<br />
<br />~ER
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<br />FLlet~MoJr.:tgage. COJr.p
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<br />", II
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<br />":'. .'::"
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<br />:RE DID THE FIRE ORIGINATE? (bedroom, bath, gar~lge, yard, etc.) Wa:te.Jr. he.a:ttJr. C.L04e.:t." . '.~'
<br />, ,:~.
<br />. .
<br />.T STARTED THIS FiRE? (cl garette, tool i. app l1a,ce, ma tch, etc.) Unde.:teJr.m.i.ne.d .i_
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<br />. : : .' I.:
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<br />.i TY?E 9F HATERIAL IGNITED.? (paper, gas', gaso'l; ne, fabd c, etc.) M.i.4 c.e.Llane,ou4 Ma:te.Jr.i~L:-:;':.,
<br />.T AIDED III THE fIRE ,SPREA.D1'(curtaln, m~ttress," \-/all '~oYerlng, etc.) 'Clle.n:t 'Unn~:t.i..c.~a " .',:,,;~~,
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<br />. -;..
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<br />
<br />FIRE LOSS INFORr~TIOH
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<br />. . . .
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<br />. .'
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<br />10'1. .
<br />
<br />VALUE
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<br />I NSUR.I\NCE
<br />COVERAGE
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<br />. LOSS'
<br />. SUSTA I NED
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<br />L 0 I riG. . . . . . . . . . S
<br />
<br />$
<br />$
<br />S
<br />
<br />$'33,000
<br />S 22,000
<br />S
<br />
<br />TEiITS... .... .. . s
<br />
<br />ER. . . . ~ . . . . . . . . s
<br />
<br />'. .
<br />
<br />....
<br />. "' ::
<br />, .""
<br />
<br />~lS . . . . . . . . . . . . s .
<br />
<br />$
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<br />$ 55,000
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<br />E: IF (ass EXCEEDS $250.000. OR IN'IOLVEO 1.10Il(T1IMI10 OUILOUlGS. OR KILLED J OR HOP.-E
<br />PERSOiIS. PLEASE ItICLUDE A SI::PI\R.I\TE, DET,'\ J ..ED REPOf\T.
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<br />'~EUTS: Th.i.4 6.i.Jr.e 1.4 4:t.i.Ll unde.Jr. .i.71Ue4:t.i.ga:t.i.on a:t ;the. :t.i.m,e b 6 .:th.i.4 ll.e.pOIl:t.
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<br />..-
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<br />
<br />Paul R. R.i.eke.nbo:t:tom-Fille. Mall4hal
<br />-, 7~~~i"CJ r. ,'Ol.q
<br />tJIP-c 1'\. ."
<br />HIS REPORT TO: .
<br />I
<br />
<br />C1.:t 0 La POIl:te. Te.X~4
<br />(t.itlt:)
<br />
<br />5'fA.'Jf. F U\E. '",^RSUAL
<br />STI\TE. GOARD OF WSU?.....,::CE
<br />, 11 io 'SAil JAC liITO
<br />. AU.ST III, TEXAS 78786
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