Laserfiche WebLink
. ' - ` i - <br /> � �1.Allegadons upon which claimant bases ciaim: <br /> He is btack. <br /> 12.Explain what actions have been taken to prevent a recurrence or similar claim: , <br /> NiA <br /> Applicant's Si�nature: �-L�� � �c�c <br /> . <br /> Oate: 3�jv�8� . <br />