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E CITY ZIP STATE VESSEL NUMBER (CF OR DOC) NONE OTHER PROPERTY # PERSONS ON BOARD ESTIMATED SPEED HORSEPOWER RENTED VESSEL DAMAGE MINOR MAJOR ESTIMATED DAMAGE $$ DISPOSITION OF VESSEL OWNERS NAME SAME OWNERS STREET / MAILING ADDRESS PHONE ( ) SAME NONE CITY STATE STATE ZIP ZIP PHONE ( INJURED / DECEASED / WITNESS WORKBOAT OTHER MODERATE TOTAL VICTIM / WITNESS STATUS RIDING IN VESSEL # DOB/ AGE INJURED DECEASED DISAPPEARED PASSENGER ONLY WITNESS ONLY NONE NOTIFI.

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