{\rtf1\ansi\ansicpg1252\uc1\deff0\stshfdbch0\stshfloch0\stshfhich0\stshfbi0\deflang1033\deflangfe1033{\fonttbl{\f0\froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;}{\f36\froman\fcharset238\fprq2 Times New Roman CE;}
{\f37\froman\fcharset204\fprq2 Times New Roman Cyr;}{\f39\froman\fcharset161\fprq2 Times New Roman Greek;}{\f40\froman\fcharset162\fprq2 Times New Roman Tur;}{\f41\froman\fcharset177\fprq2 Times New Roman (Hebrew);}
{\f42\froman\fcharset178\fprq2 Times New Roman (Arabic);}{\f43\froman\fcharset186\fprq2 Times New Roman Baltic;}{\f44\froman\fcharset163\fprq2 Times New Roman (Vietnamese);}}{\colortbl;\red0\green0\blue0;\red0\green0\blue255;\red0\green255\blue255;
\red0\green255\blue0;\red255\green0\blue255;\red255\green0\blue0;\red255\green255\blue0;\red255\green255\blue255;\red0\green0\blue128;\red0\green128\blue128;\red0\green128\blue0;\red128\green0\blue128;\red128\green0\blue0;\red128\green128\blue0;
\red128\green128\blue128;\red192\green192\blue192;\red255\green255\blue255;}{\stylesheet{\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \snext0 Normal;}{
\s1\qc \li0\ri0\keepn\widctlpar\tx360\aspalpha\aspnum\faauto\outlinelevel0\adjustright\rin0\lin0\itap0 \b\fs18\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 heading 1;}{\s2\ql \li0\ri0\keepn\widctlpar
\tx360\tqc\tx1620\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0 \b\fs16\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 heading 2;}{\*\cs10 \additive \ssemihidden Default Paragraph Font;}{\*
\ts11\tsrowd\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscellwidthfts0\tsvertalt\tsbrdrt\tsbrdrl\tsbrdrb\tsbrdrr\tsbrdrdgl\tsbrdrdgr\tsbrdrh\tsbrdrv 
\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs20\lang1024\langfe1024\cgrid\langnp1024\langfenp1024 \snext11 \ssemihidden Normal Table;}{\s15\ql \li0\ri0\widctlpar
\tqc\tx4320\tqr\tx8640\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext15 header;}{\s16\ql \li0\ri0\widctlpar
\tqc\tx4320\tqr\tx8640\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext16 footer;}}{\*\latentstyles\lsdstimax156\lsdlockeddef0}{\*\rsidtbl \rsid475961\rsid3671034\rsid5242894
\rsid10171494\rsid12412592\rsid12412948}{\*\generator Microsoft Word 11.0.5604;}{\info{\title LOSS/THEFT REPORT}{\author D V P}{\keywords AD-99}{\operator Daniel V. Pankiewicz}{\creatim\yr2007\mo3\dy26\hr13\min18}{\revtim\yr2007\mo3\dy26\hr13\min22}
{\printim\yr2001\mo9\dy18\hr17\min24}{\version2}{\edmins3}{\nofpages1}{\nofwords372}{\nofchars2122}{\*\category ADMINISTRATION}{\nofcharsws2490}{\vern24689}}\margl720\margr720\margt720\margb720 
\widowctrl\ftnbj\aenddoc\noxlattoyen\expshrtn\noultrlspc\dntblnsbdb\nospaceforul\hyphcaps0\formprot\formshade\horzdoc\dgmargin\dghspace180\dgvspace180\dghorigin720\dgvorigin720\dghshow1\dgvshow1
\jexpand\viewkind1\viewscale100\pgbrdrhead\pgbrdrfoot\splytwnine\ftnlytwnine\htmautsp\nolnhtadjtbl\useltbaln\alntblind\lytcalctblwd\lyttblrtgr\lnbrkrule\nojkernpunct\rsidroot12412948 \fet0\enforceprot1\protlevel2{\*\template 
C:\\Dan\\webdocs\\transportation\\eng\\forms\\docs\\operations\\ad99.dot}{\*\ftnsep \pard\plain \ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\insrsid10171494 \chftnsep 

\par }}{\*\ftnsepc \pard\plain \ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\insrsid10171494 \chftnsepc 
\par }}{\*\aftnsep \pard\plain \ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\insrsid10171494 \chftnsep 
\par }}{\*\aftnsepc \pard\plain \ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\insrsid10171494 \chftnsepc 
\par }}\sectd \linex0\endnhere\sectlinegrid360\sectdefaultcl\sftnbj {\header \pard\plain \s15\ql \li0\ri0\widctlpar\tqc\tx5310\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs18\insrsid5242894 
Form AD-99  }{\fs18\insrsid3671034 10/06}{\fs18\insrsid5242894 \tab }{\b\fs20\insrsid5242894 NEW JERSEY DEPARTMENT OF TRANSPORTATION
\par }\pard \s15\qc \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\b\fs21\insrsid5242894 LOSS, THEFT, AND VANDALISM REPORT
\par }}{\*\pnseclvl1\pnucrm\pnstart1\pnindent720\pnhang {\pntxta .}}{\*\pnseclvl2\pnucltr\pnstart1\pnindent720\pnhang {\pntxta .}}{\*\pnseclvl3\pndec\pnstart1\pnindent720\pnhang {\pntxta .}}{\*\pnseclvl4\pnlcltr\pnstart1\pnindent720\pnhang {\pntxta )}}
{\*\pnseclvl5\pndec\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl6\pnlcltr\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl7\pnlcrm\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl8
\pnlcltr\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl9\pnlcrm\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}\pard\plain \ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 
\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs18\insrsid5242894 
\par }\pard \ql \li0\ri0\widctlpar\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\b\fs18\insrsid5242894 \tab }{\b\fs16\insrsid5242894 INSTRUCTIONS:  PREPARE THIS FORM IN ORIGINAL AND TWO COPIES.  (SEE DISTRIBUTION BELOW.)}{\fs16\insrsid5242894 

\par }\trowd \irow0\irowband0\ts11\trgaph108\trrh474\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmgf\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalt\clbrdrt\brdrs\brdrw10 
\clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4410\clshdrawnil \cellx5940\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth2970\clshdrawnil \cellx8910\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1998\clshdrawnil \cellx10908\pard \qc \li0\ri0\widctlpar\intbl
\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\b\fs16\insrsid5242894 EMPLOYEE INFORMATION\cell }\pard \ql \li0\ri0\widctlpar\intbl\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 
Person to whom vehicle, equipment or item was assigned
\par {\*\bkmkstart Text1}}{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 {\*\datafield 000000001400000005546578743100000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text1}}}}}{\fldrslt {
\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20\insrsid5242894 {\*\bkmkend Text1}\cell }{\fs16\insrsid5242894 Title
\par {\*\bkmkstart Text2}}{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 {\*\datafield 000000001400000005546578743200000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text2}}}}}{\fldrslt {
\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20\insrsid5242894 {\*\bkmkend Text2}\cell }{\fs16\insrsid5242894 Business telephone
\par {\*\bkmkstart Text3}}{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 {\*\datafield 000000001400000005546578743300000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text3}}}}}{\fldrslt {
\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20\insrsid5242894 {\*\bkmkend Text3}\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 
\trowd \irow0\irowband0\ts11\trgaph108\trrh474\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmgf\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalt\clbrdrt\brdrs\brdrw10 
\clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4410\clshdrawnil \cellx5940\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth2970\clshdrawnil \cellx8910\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1998\clshdrawnil \cellx10908\row }\trowd \irow1\irowband1
\ts11\trgaph108\trrh474\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmrg\clvertalt
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth4410\clshdrawnil \cellx5940\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4968\clshdrawnil \cellx10908\pard \ql \li0\ri0\widctlpar\intbl
\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 \cell Bureau
\par {\*\bkmkstart Text4}}{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 {\*\datafield 000000001400000005546578743400000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text4}}}}}{\fldrslt {
\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20\insrsid5242894 {\*\bkmkend Text4}\cell }{\fs16\insrsid5242894 Location of official work station
\par {\*\bkmkstart Text5}}{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 {\*\datafield 000000001400000005546578743500000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text5}}}}}{\fldrslt {
\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20\insrsid5242894 {\*\bkmkend Text5}\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 
\trowd \irow1\irowband1\ts11\trgaph108\trrh474\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalt\clbrdrt\brdrs\brdrw10 
\clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4410\clshdrawnil \cellx5940\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth4968\clshdrawnil \cellx10908\row }\trowd \irow2\irowband2\ts11\trgaph108\trrh474\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv
\brdrs\brdrw10 \trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalt\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth5040\clshdrawnil \cellx6570\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth4338\clshdrawnil \cellx10908\pard \ql \li0\ri0\widctlpar\intbl\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 \cell Person completing this report (if different than above)
\par {\*\bkmkstart Text7}}{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 {\*\datafield 000000001400000005546578743700000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text7}}}}}{\fldrslt {
\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20\insrsid5242894 {\*\bkmkend Text7}\cell }{\fs16\insrsid5242894 Title
\par {\*\bkmkstart Text6}}{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 {\*\datafield 000000001400000005546578743600000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text6}}}}}{\fldrslt {
\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20\insrsid5242894 {\*\bkmkend Text6}\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 
\trowd \irow2\irowband2\ts11\trgaph108\trrh474\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalt\clbrdrt\brdrs\brdrw10 
\clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth5040\clshdrawnil \cellx6570\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth4338\clshdrawnil \cellx10908\row }\trowd \irow3\irowband3\lastrow \ts11\trgaph108\trrh475\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 
\trbrdrv\brdrs\brdrw10 \trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalt
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4410\clshdrawnil \cellx5940\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth2970\clshdrawnil \cellx8910\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1998\clshdrawnil \cellx10908\pard \ql \li0\ri0\widctlpar\intbl
\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 \cell Bureau
\par {\*\bkmkstart Text8}}{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 {\*\datafield 000000001400000005546578743800000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text8}}}}}{\fldrslt {
\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20\insrsid5242894 {\*\bkmkend Text8}\cell }{\fs16\insrsid5242894 Location of official work station
\par {\*\bkmkstart Text9}}{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 {\*\datafield 000000001400000005546578743900000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text9}}}}}{\fldrslt {
\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20\insrsid5242894 {\*\bkmkend Text9}\cell }{\fs16\insrsid5242894 Business telephone
\par {\*\bkmkstart Text10}}{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 {\*\datafield 00000000140000000654657874313000000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text10}}}}}{\fldrslt {
\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20\insrsid5242894 {\*\bkmkend Text10}\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 
\trowd \irow3\irowband3\lastrow \ts11\trgaph108\trrh475\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalt\clbrdrt\brdrs\brdrw10 
\clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4410\clshdrawnil \cellx5940\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth2970\clshdrawnil \cellx8910\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1998\clshdrawnil \cellx10908\row }\pard \ql \li0\ri0\widctlpar
\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\fs18\insrsid5242894 
\par }\trowd \irow0\irowband0\ts11\trgaph108\trrh474\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmgf\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalt\clbrdrt\brdrs\brdrw10 
\clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2160\clshdrawnil \cellx3690\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth7218\clshdrawnil \cellx10908\pard \qc \li0\ri0\widctlpar\intbl\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\b\fs16\insrsid5242894 INFORMATION CONCERNING THE LOSS, THEFT OR VANDALISM\cell }\pard 
\ql \li0\ri0\widctlpar\intbl\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 Date of loss or damage
\par }{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 {\*\datafield 000000001400000005546578743100000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text1}}}}}{\fldrslt {
\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20\insrsid5242894 \cell }{\fs16\insrsid5242894 Location where loss or damage occurred, including Region
\par }{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 {\*\datafield 000000001400000005546578743200000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text2}}}}}{\fldrslt {
\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20\insrsid5242894 \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 
\trowd \irow0\irowband0\ts11\trgaph108\trrh474\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmgf\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalt\clbrdrt\brdrs\brdrw10 
\clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2160\clshdrawnil \cellx3690\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth7218\clshdrawnil \cellx10908\row }\trowd \irow1\irowband1\ts11\trgaph108\trrh458\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv
\brdrs\brdrw10 \trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalt\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9378\clshdrawnil \cellx10908\pard \ql \li0\ri0\widctlpar\intbl\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 
\cell How did you learn of the loss, theft or vandalism?  (Describe your findings)
\par }{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 {\*\datafield 000000001400000005546578743400000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text4}}}}}{\fldrslt {
\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20\insrsid5242894 \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 
\trowd \irow1\irowband1\ts11\trgaph108\trrh458\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalt\clbrdrt\brdrs\brdrw10 
\clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9378\clshdrawnil \cellx10908\row }\trowd \irow2\irowband2\ts11\trgaph108\trrh359\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb
\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalb\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9378\clshdrawnil \cellx10908\pard \ql \li0\ri0\widctlpar\intbl
\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 \cell }{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 {\*\datafield 000000001400000005546578743700000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text7}}}}}{\fldrslt {\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20\insrsid5242894 \cell }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 \trowd \irow2\irowband2\ts11\trgaph108\trrh359\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 
\trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalb\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9378\clshdrawnil \cellx10908\row }\trowd \irow3\irowband3
\ts11\trgaph108\trrh350\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmrg\clvertalt
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalb\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth9378\clshdrawnil \cellx10908\pard \ql \li0\ri0\widctlpar\intbl\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 \cell {\*\bkmkstart Text21}}{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{
\fs20\insrsid475961 {\*\datafield 00000000140000000654657874323100000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text21}}}}}{\fldrslt {\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20
\u8194\'20}}}{\fs20\insrsid5242894 {\*\bkmkend Text21}\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 \trowd \irow3\irowband3\ts11\trgaph108\trrh350\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 
\trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalb\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9378\clshdrawnil \cellx10908
\row }\trowd \irow4\irowband4\lastrow \ts11\trgaph108\trrh475\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalc\clbrdrt\brdrs\brdrw10 
\clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4410\clshdrawnil \cellx5940\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth4968\clshdrawnil \cellx10908\pard \ql \li0\ri0\widctlpar\intbl\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 \cell Did anyone witness the theft or vandalism?
\par }\pard \ql \li0\ri0\widctlpar\intbl\tx342\tx702\tx1242\tx1602\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 \tab {\*\bkmkstart Check7}}{\field\flddirty\fldpriv{\*\fldinst {\fs18\insrsid5242894  FORMCHECKBOX }{\fs18\insrsid475961 
{\*\datafield 650000001400000006436865636b3700000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check7}\ffdefres0}}}}{\fldrslt }}{\fs16\insrsid5242894 {\*\bkmkend Check7}\tab Yes\tab {\*\bkmkstart Check8}}
{\field\flddirty\fldpriv{\*\fldinst {\fs18\insrsid5242894  FORMCHECKBOX }{\fs18\insrsid475961 {\*\datafield 650000001400000006436865636b3800000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check8}\ffdefres0}}}
}{\fldrslt }}{\fs16\insrsid5242894 {\*\bkmkend Check8}\tab No\tab \cell }\pard \ql \li0\ri0\widctlpar\intbl\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 Name and address of witness
\par }{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 {\*\datafield 000000001400000005546578743900000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text9}}}}}{\fldrslt {
\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20\insrsid5242894 \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 
\trowd \irow4\irowband4\lastrow \ts11\trgaph108\trrh475\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalc\clbrdrt\brdrs\brdrw10 
\clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4410\clshdrawnil \cellx5940\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth4968\clshdrawnil \cellx10908\row }\pard \ql \li0\ri0\widctlpar\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\fs18\insrsid5242894 
\par }\trowd \irow0\irowband0\ts11\trgaph108\trrh474\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmgf\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalt\clbrdrt\brdrs\brdrw10 
\clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4410\clshdrawnil \cellx5940\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth1620\clshdrawnil \cellx7560\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth942\clshdrawnil \cellx8502\clvertalt\clbrdrt\brdrs\brdrw10 
\clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2406\clshdrawnil \cellx10908\pard \qc \li0\ri0\widctlpar\intbl\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\b\fs16\insrsid5242894 
DESCRIPTION OF VEHICLE OR EQUIPMENT\cell }\pard \ql \li0\ri0\widctlpar\intbl\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 Type of vehicle or equipment
\par }{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 {\*\datafield 000000001400000005546578743100000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text1}}}}}{\fldrslt {
\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20\insrsid5242894 \cell }{\fs16\insrsid5242894 Make
\par {\*\bkmkstart Text11}}{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 {\*\datafield 00000000140000000654657874313100000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text11}}}}}{\fldrslt {
\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20\insrsid5242894 {\*\bkmkend Text11}\cell }{\fs16\insrsid5242894 Year
\par {\*\bkmkstart Text12}}{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 {\*\datafield 00000000140000000654657874313200000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text12}}}}}{\fldrslt {
\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20\insrsid5242894 {\*\bkmkend Text12}\cell }{\fs16\insrsid5242894 License or equipment number
\par {\*\bkmkstart Text13}}{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 {\*\datafield 00000000140000000654657874313300000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {
\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20\insrsid5242894 {\*\bkmkend Text13}\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 
\trowd \irow0\irowband0\ts11\trgaph108\trrh474\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmgf\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalt\clbrdrt\brdrs\brdrw10 
\clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4410\clshdrawnil \cellx5940\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth1620\clshdrawnil \cellx7560\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth942\clshdrawnil \cellx8502\clvertalt\clbrdrt\brdrs\brdrw10 
\clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2406\clshdrawnil \cellx10908\row }\trowd \irow1\irowband1\ts11\trgaph108\trrh521\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb
\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9378\clshdrawnil \cellx10908\pard \ql \li0\ri0\widctlpar\intbl
\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 \cell Indicate any other details of the lost or stolen items which may aid in identifying them
\par }{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 {\*\datafield 000000001400000005546578743400000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text4}}}}}{\fldrslt {
\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20\insrsid5242894 \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 
\trowd \irow1\irowband1\ts11\trgaph108\trrh521\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalt\clbrdrt\brdrs\brdrw10 
\clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9378\clshdrawnil \cellx10908\row }\trowd \irow2\irowband2\ts11\trgaph108\trrh332\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb
\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalb\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9378\clshdrawnil \cellx10908\pard \ql \li0\ri0\widctlpar\intbl
\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 \cell }{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 {\*\datafield 000000001400000005546578743700000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text7}}}}}{\fldrslt {\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20\insrsid5242894 \cell }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 \trowd \irow2\irowband2\ts11\trgaph108\trrh332\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 
\trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalb\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9378\clshdrawnil \cellx10908\row }\trowd \irow3\irowband3\lastrow 
\ts11\trgaph108\trrh323\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmrg\clvertalt
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalb\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth9378\clshdrawnil \cellx10908\pard \ql \li0\ri0\widctlpar\intbl\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 \cell {\*\bkmkstart Text22}}{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{
\fs20\insrsid475961 {\*\datafield 00000000140000000654657874323200000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text22}}}}}{\fldrslt {\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20
\u8194\'20}}}{\fs20\insrsid5242894 {\*\bkmkend Text22}\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 \trowd \irow3\irowband3\lastrow \ts11\trgaph108\trrh323\trleft-108\trkeep\trbrdrt
\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalb\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9378\clshdrawnil 
\cellx10908\row }\pard \ql \li0\ri0\widctlpar\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\fs18\insrsid5242894 
\par }\trowd \irow0\irowband0\ts11\trgaph108\trrh530\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmgf\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalb\clbrdrt\brdrs\brdrw10 
\clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9378\clshdrawnil \cellx10908\pard \qc \li0\ri0\widctlpar\intbl\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\b\fs16\insrsid5242894 
DESCRIPTION OF ITEMS INCLUDING NON-EXPENDABLE INVENTORY OTHER THAN VEHICLES AND EQUIPMENT\cell }\pard \ql \li0\ri0\sa120\widctlpar\intbl\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 
Non-Expendable  NJDOT   ID Number, if applicable
\par }\pard \ql \li0\ri0\widctlpar\intbl\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 {\*\datafield 000000001400000005546578743100000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text1}}}}}{\fldrslt {\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20\insrsid5242894 \cell }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 \trowd \irow0\irowband0\ts11\trgaph108\trrh530\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 
\trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmgf\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalb\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9378\clshdrawnil \cellx10908\row }\trowd \irow1\irowband1
\ts11\trgaph108\trrh474\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmrg\clvertalt
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalb\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth9378\clshdrawnil \cellx10908\pard \ql \li0\ri0\widctlpar\intbl\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 \cell }{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 
{\*\datafield 000000001400000005546578743400000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text4}}}}}{\fldrslt {\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{
\fs20\insrsid5242894 \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 \trowd \irow1\irowband1\ts11\trgaph108\trrh474\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb
\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalb\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9378\clshdrawnil \cellx10908\row }\trowd \irow2\irowband2
\ts11\trgaph108\trrh456\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmrg\clvertalt
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalb\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth9378\clshdrawnil \cellx10908\pard \ql \li0\ri0\widctlpar\intbl\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 \cell }{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 
{\*\datafield 000000001400000005546578743700000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text7}}}}}{\fldrslt {\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{
\fs20\insrsid5242894 \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 \trowd \irow2\irowband2\ts11\trgaph108\trrh456\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb
\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalb\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9378\clshdrawnil \cellx10908\row }\trowd \irow3\irowband3\lastrow 
\ts11\trgaph108\trrh474\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmrg\clvertalt
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth9378\clshdrawnil \cellx10908\pard \ql \li0\ri0\widctlpar\intbl\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 \cell VALUE:\tab {\*\bkmkstart Text23}}{\field{\*\fldinst {\fs20\insrsid5242894 
 FORMTEXT }{\fs20\insrsid475961 {\*\datafield 00000000140000000654657874323300000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text23}}}}}{\fldrslt {\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194
\'20\u8194\'20\u8194\'20}}}{\fs16\insrsid5242894 {\*\bkmkend Text23}\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 \trowd \irow3\irowband3\lastrow \ts11\trgaph108\trrh474\trleft-108\trkeep
\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth9378\clshdrawnil \cellx10908\row }\pard \ql \li0\ri0\widctlpar\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\fs18\insrsid5242894 
\par }\trowd \irow0\irowband0\ts11\trgaph108\trrh509\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmgf\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1687\clshdrawnil \cellx1579\clvertalt\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4271\clshdrawnil \cellx5850\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth5058\clshdrawnil \cellx10908\pard \qc \li0\ri0\widctlpar\intbl\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\b\fs16\insrsid5242894 POLICE INVESTIGATION\cell }\pard \ql \li0\ri0\widctlpar\intbl
\tx360\tx2453\tx2813\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 Did you notify the Police?\tab {\*\bkmkstart Check3}}{\field\flddirty\fldpriv{\*\fldinst {\fs18\insrsid5242894  FORMCHECKBOX }{\fs18\insrsid475961 {\*\datafield 
650000001400000006436865636b3300000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check3}\ffdefres0}}}}{\fldrslt }}{\fs16\insrsid5242894 {\*\bkmkend Check3}\tab State Police
\par }\pard \ql \li0\ri0\sb120\widctlpar\intbl\tx293\tx653\tx1193\tx1553\tx2453\tx2813\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 \tab {\*\bkmkstart Check4}}{\field\flddirty\fldpriv{\*\fldinst {\fs18\insrsid5242894  FORMCHECKBOX }{
\fs18\insrsid475961 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}}{\fldrslt }}{\fs18\insrsid5242894 {\*\bkmkend Check4}\tab }{\fs16\insrsid5242894 
Yes\tab {\*\bkmkstart Check5}}{\field\flddirty\fldpriv{\*\fldinst {\fs18\insrsid5242894  FORMCHECKBOX }{\fs18\insrsid475961 {\*\datafield 650000001400000006436865636b3500000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname 
Check5}\ffdefres0}}}}{\fldrslt }}{\fs16\insrsid5242894 {\*\bkmkend Check5}\tab No\tab {\*\bkmkstart Check6}}{\field\flddirty\fldpriv{\*\fldinst {\fs18\insrsid5242894  FORMCHECKBOX }{\fs18\insrsid475961 {\*\datafield 
650000001400000006436865636b3600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check6}\ffdefres0}}}}{\fldrslt }}{\fs16\insrsid5242894 {\*\bkmkend Check6}\tab Local Police\cell }\pard \ql \li0\ri0\widctlpar\intbl
\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 If Police were notified indicate name of department and address
\par {\*\bkmkstart Text14}}{\field{\*\fldinst {\fs18\insrsid5242894  FORMTEXT }{\fs18\insrsid475961 {\*\datafield 00000000140000000654657874313400000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text14}}}}}{\fldrslt {
\fs18\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs18\insrsid5242894 {\*\bkmkend Text14}\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 
\trowd \irow0\irowband0\ts11\trgaph108\trrh509\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmgf\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1687\clshdrawnil \cellx1579\clvertalt\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4271\clshdrawnil \cellx5850\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth5058\clshdrawnil \cellx10908\row }\trowd \irow1\irowband1\lastrow \ts11\trgaph108\trrh510\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 
\trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1687\clshdrawnil \cellx1579
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3101\clshdrawnil \cellx4680\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth6228\clshdrawnil \cellx10908\pard \ql \li0\ri0\widctlpar\intbl\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 \cell When did you notify the Police?
\par {\*\bkmkstart Text15}}{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 {\*\datafield 00000000140000000654657874313500000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text15}}}}}{\fldrslt {
\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20\insrsid5242894 {\*\bkmkend Text15}\cell }{\fs16\insrsid5242894 Name of the officer to whom you reported the theft or vandalism
\par {\*\bkmkstart Text16}}{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 {\*\datafield 00000000140000000654657874313600000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text16}}}}}{\fldrslt {
\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20\insrsid5242894 {\*\bkmkend Text16}\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 
\trowd \irow1\irowband1\lastrow \ts11\trgaph108\trrh510\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1687\clshdrawnil \cellx1579\clvertalt\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3101\clshdrawnil \cellx4680\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth6228\clshdrawnil \cellx10908\row }\pard \ql \li0\ri0\widctlpar\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\fs18\insrsid5242894 
\par }\trowd \irow0\irowband0\ts11\trqc\trgaph108\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth3098\clshdrawnil \cellx2990\clvmgf\clvertalt\clbrdrt\brdrnone \clbrdrl
\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth288\clshdrawnil \cellx3278\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth3584\clshdrawnil \cellx6862
\pard \qc \li0\ri0\widctlpar\intbl\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\*\bkmkstart Text17}{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 {\*\datafield 00000000140000000654657874313700000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text17}}}}}{\fldrslt {\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20\insrsid5242894 {\*\bkmkend Text17}\cell }\pard 
\ql \li0\ri0\widctlpar\intbl\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs18\insrsid5242894 \cell \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs18\insrsid5242894 \trowd \irow0\irowband0
\ts11\trqc\trgaph108\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalt
\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth3098\clshdrawnil \cellx2990\clvmgf\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone 
\cltxlrtb\clftsWidth3\clwWidth288\clshdrawnil \cellx3278\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth3584\clshdrawnil \cellx6862\row }\trowd \irow1\irowband1\lastrow 
\ts11\trqc\trgaph108\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalt
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth3098\clshdrawnil \cellx2990\clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone 
\cltxlrtb\clftsWidth3\clwWidth288\clshdrawnil \cellx3278\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth3584\clshdrawnil \cellx6862\pard \qc \li0\ri0\widctlpar\intbl
\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs18\insrsid5242894 Date of this report\cell }\pard \ql \li0\ri0\widctlpar\intbl\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs18\insrsid5242894 \cell 
Signature of person completing this report\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs18\insrsid5242894 \trowd \irow1\irowband1\lastrow \ts11\trqc\trgaph108\trleft-108\trkeep\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr
\brdrnone \cltxlrtb\clftsWidth3\clwWidth3098\clshdrawnil \cellx2990\clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth288\clshdrawnil \cellx3278\clvertalt\clbrdrt\brdrs\brdrw10 
\clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth3584\clshdrawnil \cellx6862\row }\pard \ql \li0\ri0\widctlpar\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\fs18\insrsid5242894 
\par }\trowd \irow0\irowband0\ts11\trgaph108\trrh377\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth11016\clshdrawnil \cellx10908\pard\plain 
\s1\qc \li0\ri0\keepn\widctlpar\intbl\tx360\aspalpha\aspnum\faauto\outlinelevel0\adjustright\rin0\lin0 \b\fs18\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs17\insrsid5242894 DO NOT WRITE BELOW THIS LINE \endash  FOR INVESTIGATION USE ONLY\cell 
}\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs16\insrsid5242894 \trowd \irow0\irowband0\ts11\trgaph108\trrh377\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth11016\clshdrawnil \cellx10908\row }\trowd \irow1\irowband1\ts11\trgaph108\trrh440\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh
\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth8956\clshdrawnil 
\cellx8848\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2060\clshdrawnil \cellx10908\pard \ql \li0\ri0\widctlpar\intbl
\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 Referred for investigation to
\par {\*\bkmkstart Text19}}{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 {\*\datafield 00000000140000000654657874313900000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text19}}}}}{\fldrslt {
\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20\insrsid5242894 {\*\bkmkend Text19}\cell }{\fs16\insrsid5242894 Date assigned
\par {\*\bkmkstart Text18}}{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 {\*\datafield 00000000140000000654657874313800000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text18}}}}}{\fldrslt {
\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20\insrsid5242894 {\*\bkmkend Text18}\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 
\trowd \irow1\irowband1\ts11\trgaph108\trrh440\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth8956\clshdrawnil \cellx8848\clvertalt\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2060\clshdrawnil \cellx10908\row }\trowd \irow2\irowband2\ts11\trgaph108\trrh449\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 
\trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth11016\clshdrawnil \cellx10908\pard \ql \li0\ri0\widctlpar\intbl\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 Comments
\par {\*\bkmkstart Text20}}{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 {\*\datafield 00000000140000000654657874323000000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text20}}}}}{\fldrslt {
\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20\insrsid5242894 {\*\bkmkend Text20}\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 
\trowd \irow2\irowband2\ts11\trgaph108\trrh449\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth11016\clshdrawnil \cellx10908\row 
}\trowd \irow3\irowband3\ts11\trgaph108\trrh440\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth11016\clshdrawnil \cellx10908\pard 
\ql \li0\ri0\widctlpar\intbl\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\*\bkmkstart Text24}{\field{\*\fldinst {\fs20\insrsid5242894  FORMTEXT }{\fs20\insrsid475961 {\*\datafield 00000000140000000654657874323400000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text24}}}}}{\fldrslt {\fs20\lang1024\langfe1024\noproof\insrsid5242894 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\fs20\insrsid5242894 {\*\bkmkend Text24}\cell }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 \trowd \irow3\irowband3\ts11\trgaph108\trrh440\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh
\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth11016\clshdrawnil 
\cellx10908\row }\trowd \irow4\irowband4\lastrow \ts11\trgaph108\trrh701\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth11016\clshdrawnil \cellx10908\pard\plain 
\s2\ql \li0\ri0\sb120\keepn\widctlpar\intbl\tx360\tx1440\tx2160\tx2880\tx3600\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\pararsid3671034 \b\fs16\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\insrsid5242894 DISTRIBUTION:\tab 
ORIGINAL TO:\tab Internal Investigations Unit, Department of Transportation, }{\insrsid3671034 P.O. Box  600, Trenton, Ó£»¨ÊÓƵ 08625}{\insrsid5242894 \tab \tab \tab \tab DUPLICATE:\tab Furniture Control Section, Bureau of Central Warehouse Operations.

\par }\pard\plain \ql \li0\ri0\widctlpar\intbl\tx360\tx1440\tqc\tx1620\tx2160\tx2880\tx3600\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\fs16\insrsid5242894 \tab \tab DUPLICATE:\tab Retain for File.
\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\fs16\insrsid5242894 \trowd \irow4\irowband4\lastrow \ts11\trgaph108\trrh701\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr
\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth11016\clshdrawnil \cellx10908\row }\pard \ql \li0\ri0\widctlpar\tx360\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\fs18\insrsid5242894 
\par }}