HOUSE OVERSIGHT 018962 Date: 7/13/06 Time: 9:27:55 PALM BEACH POLICE DEPARTMENT Page: 9 Incident Report Program: CMS301L Case No.....• 1-05-000368 Can Identify . Injury Extent Injury Type 2 Med Treatment Phys Last Name : *********OTHER PERSON City ......: Case Number . : 1-05-000368 • ___________________Lart Name . : Street Number I Birth Date/Age : I Occupation . . : STUDENT Home Phone No. I I Sex ......• Female Weight ..... 0 Other Phone Nbr: *********,OTHER PERS Case Number . : 1-05-000368 Street Number : City ...... Birth Date/Age Dccupation . . *71ome Phone No. 3ex ...... geight ..... )ther Phone Nbr: 0 Employer? . Oper Lic No. Race ......• White Height . . . : 0 Person Type : OTHER PERSON INFORMATION T. st Name . . : _[ Female 0 k******** OTHER PERSON :lase Number . : 1-05-000368 3treet Number : :ity ...... 3irth Date/Age : )ccupation kme Phone No. : lex ...... fedght ..... ftlier Phone Nbr: Employer? . Oper Lic No. Victim Sobriety: Injury Type 1 : Hospital ID Phys First Name: (Continued) INFORMATION- 1 ********* b6 b7C _ # 2 ********* '1_______________________________ Race ......• White Height .....• 510 Person Type : OTHER PERSON b6 b7C INFORMATION - # 3 ********* Last Name . . :1 1 Female 0 '******** OTHER PERSO.N !ase Number . : 1-05-000368 ltreet Number aty ...... drth Date/Age : )ccupation . . brae Phone No. ex 'eight .....• 0 • ther Phone Nbr: Employer? . Oper Lic No. Race ......• White Height ..... 0 Person Type : OTHER PERSON INFORMATION Lasl Name ......• Male ********OTHER PERSON ase Number . : 1-05-000368 - # 4 ********* Employer? Oper Lic No. Race ......• White Height ..... 0 Person Type : OTHER PERSON INFORMATION - 5 ********* Last Name . .