HomeMy WebLinkAboutPRR25093 LexisNexis - 1813 Gathe Fire Reportls'll
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TEN DOLLARSAND NOCENTS
SAN LUIS OBISPO FIRE DEPT
FIRE RECORDS DEPT
2160 SANTA BARBARA ST
SAN LUIS OBISPO,CA 93401
5.1 907
DArE 1129125
$ 10,00
AMOUNT
VOID AFTER 18 MONTHS
fl LexisNexis'
Vehicle lnfo
VIN
P.O.BOX 74A025
='AETLANTA,
GA 30374-0025
= 6V8.9!A:4900 FAX 800.934.6449
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PAY TO
TRAN: 31 1e804251
Agency lnfo
Date of Occurrence 0'1/05/2025 00:00
ReporUCase #25-00080
Type of Report Fire Building
Agency Name SAN LUIS OBISPO FD
precinct or District DET KOZNEK
City of Loss SAN LUIS OBISPO
County of Loss SAN LUIS OBlSPSlate CA
1813 GATHE DR
REQUEST FORM
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Car Tag
Make
Tag State
Year
Location of
LARGE HOUSE FIREAdditional lnfo
Involved Parties
Search Results
O Report Attached - Cost # of Pages (lncl Req Form)_
O No Report Found - Possible Jurisdiction_
O No Report Written - Log Entry or Driver Exchange Only
O Report Not Ready - Reaso
O Report Not Releasable - Reason
Comments
lnsured Party
Date of Birth SS#
Driver's Li License State
Driver #2
Driver #3
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*This request may include confidential information. As an entity authorized to receive this information you agree that after responding to
LexisNexis you will appropriately protect this information against any unauthorized reading, distribution, copying or other use. lf you do
not have a report for this request, please return this form to LexisNexis and then immediately destroy any copies.
LexisNexis lnternal Use Only Below This Line USWBOW41
Client
Pagelofl Division
207857
RK
7008522832-1
1129125
Claims Adjuster
TERRY DUVALL
T
5.1907AR
Claim #
TRAN: 31 1e804251
Agency lnfo
Date of Occurrence 01i 05/2025 00:00
ReporUCase #25-00080
Type of Report Fire Building
Agency Name SAN LUIS OBISPO FD
precinct or District DET KOZNEK
City of Loss SAN LUIS OBISPO
County of Loss SAN LUIS OBlsryut"----- Jl
Location of 1813 GATHE DR
Additionailnfo LARGE HOUSE FIRE
lnvolved Parties
lnsured Party
Car Tag State
M Year
O Report Attached - Cost # of Pages (lncl Req Form)_
O No Report Found - Possible Jurisdiction_
O No Report Written - Log Entry or Driver Exchange Only
O Report Not Ready -
O Report Not Releasable - Reaso
Comments
SECOND REQUEST
*This request may include confidential information. As an entity authorized to receive this information you agree that after responding to
LexisNexis you will appropriately protect this information against any unauthorized reading, distribution, copying or other use. lf you do
not have a report for this request, please return this form to LexisNexis and then immediately destroy any copies.
LexisNexis lnternal Use Only Below This Line
Ill]]llililil]tililt
Client
Pagelof 1 Division
207857 Ctaim #
RK
7008522832-1
1t29t25
T
5.1907AR
Claims Adjuster USWBOW41