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OE ee a” I peti of ath ibe s ow | NAME: Mas. oa an ies - " ii ye MISS me <s\ 50 Caen Su has | PERMANENT (number) (street) WAUO mae (city) (state) (zip) RESIDENCE ar IS10o MonRor WEN CE: ADDRESS LANA AEORGA RESIDENCE TELEPHONE '*"*2 code mbar 3154149 OCCUPATION EMPLOYER/ (number) (street) _ , (city) _ (state) (zip) MILITARY/SCHOOL 31S 4198 . ADDRESS ; BUSINESS {area code/number} SOCIAL SECURITY NUMBER TELEPHONE . PASSPORT NUMBER LiByA GG 39,4990 47" MILITARY SERIAL NUMBER - (city) (state) (street) TEMPORARY (number) ADDRESS DURATION OF - (days) STAY 7 (date) JANOI JAVG2 TELEPHONE (flight number) SOS Ol (airline) | BA Yu FLIGHT ITINERARY WAS EXCESS VALUE DECLARED? YES No NO Attach copy of Ticket oSo73 PASSENGER TICKET NUMBER 146 44 jad Attach copy of Ticket .- , BAGGAGE CHECKED AT Rome _ AIRPORT. _CITY BAGGAGE LAST SEEN AT” Romy BAGGAGE CHECKED TO (CITY SHOWN ON TAG) I LATA ON (AIRLINE/FLIGHT NUMBER) QU FINAL DESTINATION PLANTA NUMBER OF BAGS CHECKED 3 WEIGHT OF BAGS CHECKED NUMBER OF BAGS RECEIVED \ WEIGHT OF BAG(S) MISSING ° BAGGAGE TAG NUMBER(S) OF BAG(S) MISSING = a ae Ww | CONTENTS OF MISSING sAGGAGE ARE: =a | MALE FEMALE MIXEO___ OTHER TON _ . # WAS BAGGAGE RECHECKED AND NEW TAGS ISSUED? ; | DESCRIPTION OF MISSING BAGGAGE (CHART ATTACHED) | | -& {croup (AB ree __ cost? 75.00 _ ¢ cocon _GRy _ size —_— 19 xX Gey 4. | MATERIAL BRAND “fy. | MARKINGS (LABELS, ETC) . . : “ N -. WAS AIRLINE NOTIFIED OF LOSS IMMEDIATELY? _V~ YES ___NO. IF aa AT | time \AAS pate MW) O2 BY TELEPHONE ORINPERSON? 1M) PeERSyJ IF AIRLINE WAS NOT NOTIFIED, STATE REASON FOR DELAY HAS LOSS BEEN REPORTED TO ANY OTHER AIRLINE V_ YES NO. IF YES, TO WHOM? Cask Ahan $7 ANY OTHER RELEVANT CETAILS “| HAVE YOU HAD PREVIOUS BAGGAGE LOSSES YES _W_NO. IF YES, GIVE NAME OF AIRLINE ANO DATE OF LOSS rem shat ete items gee ne 8 Ter RR PTEMBER