77 Complaint 2000 A.
PY
Date: ///j1/4,p T
Time: M
Map: P
Parcel:
Name of Complainant:
Address' 77 iiin Dc 5 T
Tel:SW 0
NATURE O FCOMPLAINT:
N
Location: 77 f1J SDK Pre,.
O
Owner: y
StGc_
/ T
Tel: 53i-7DAtldress: /
7
Taken by: ,9/ ,
Inspector Signature