Laserfiche WebLink
~Y~~ <br />FI°~E LOSS ~t~OrtT <br />STATE FIRE MARSHAL <br />FIRE PREVEP1TIOr~; SECTIOr~r <br />~r'lE OF <br />ALARr•1 11 :07 ~-,_~,41E 2-25 ~ 19 81 CITY. CR COUNTY Harris ,TEXAS <br />LOCATIOrd 208 North 2nd, La Porte TEXAS <br />OCCUPA~;CY residence COr~S T RUCTION frame <br />OCCUPANT • Charles Shephard r~rUriBER OF PERSGt1S r•iADE HOi~1ELESS <br />O'~tP1ER R.W. Coward ADDRESS. 211 Sotuh "Y" , La ~ Porte <br />WHERE DID THE FIRE ORIGINATE? (bedroom, bath, garage, yard, etc.) bedroom <br />WHAT STAP.TED THIS FIRE? (cigarette, tool, appliance, match, etc.) unknown <br />WHAT T'fPE OF tdATERIAL IGi~iTED? (paper, gas, gasoline, fabric, etc.)flammable liquid <br />WHAT AIDED Iir THE FIRE SPP.EAD? (curtain, mattress, wall covering, etc.) bedspread <br />FIRE LOSS IrJFORriAT ION <br />. ~ INSURANCE <br />VALUE CO~lERAGE <br />~ILDIr~lG..........$ ---- $ - <br />COr1TENTS..........$ $ <br />OTHER ....:........$ $ <br />TOTALS............$ ~ $ <br />LOSS <br />SUSTAINED <br />$ 5,000 _ <br />$ 2,000 <br />$ <br />$ 7,000 . <br />NOTE: IF LOSS EXCEEDS $250,000, OR Ir;VOLVED r•10RE THAr~ 10 6UILDINGS, OR KILLED 3 OR ~1oRE ,~ <br />PERSOr~S, PLEASE INCLUDE A SEPARATE, DETAILED REPORT. <br />COr',MErJTS: Flammable liquid was poured in the bedroom and lit <br />• ~/~ i}-yv----1 <br />signature of person ccmpleting report) <br />h1AIL THIS REPORT T0: <br />STATE FIRE MARSHAL <br />STATE 60ARD OF Ir;SL'P,Ar;CE <br />1110 SAN JACINTO - <br />AUSTIr1, TEXAS 78786 p - <br />~l0 <br />(title) <br />