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“Cousin It” Adams 1313 Mockingbird Way Tulelake, CA 96134. ADDRESS. AGE. APPLY HERE. APPLICATION. 4 /xx/xx. APRIL. 8 /xx/xx. AUGUST. AUTHORIZED PERSONNEL ONLY. CAUTION. CITY. Modoc. Siskiyou. Klamath. Josephine. COUNTY. DANGEROUS. 6/17/82. 10/7/05. 11/24/05. DATE.

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“Cousin It” Adams

1313 Mockingbird Way

Tulelake, CA 96134






4/xx/xx



8/xx/xx






Modoc

Siskiyou

Klamath

Josephine




6/17/82

10/7/05

11/24/05







12/xx/xx




$

BOSS



2/xx/xx





1/xx/xx



7/xx/xx



6/xx/xx






3/xx/xx



5/xx/xx








11/xx/xx



10/xx/xx



867-5309

348-3927




REPORT

Name Johnny Bravo

Description of Accident

I fell and broke my arm.

___________________





9/xx/xx



John Doe

X _________________________





WV

CA

AZ

OR

AK

WA

UT

NY

NV

NM

ID

VA

CO

MT










1492

1776

2005

1812

1991



77831

96134

97601



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