Internal Affairs Unit - Cleveland.com
Internal Affairs Unit - Cleveland.com
Internal Affairs Unit - Cleveland.com
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IN 02: OOPM 1./15/10<br />
OUT 02:02PM 1/1.4/10<br />
UNIT 1<br />
UNIT /I<br />
LIC/I<br />
MODEL<br />
COLOR<br />
IN 242<br />
OUT 113<br />
CLAIM INFO<br />
POL/CLAIM/PO#<br />
INSURED<br />
24-HOUR DAY<br />
LOSS DATE<br />
TSEFT ACCIDENT<br />
TYPE CAR<br />
SHOP<br />
PHONE<br />
NAME<br />
RENTER<br />
SOURCE<br />
CLEVELAND OH 44102-<br />
LOCAL:<br />
(H)<br />
DR. LICENSE XXXX<br />
STATE OH EXPIRE<br />
DOB /62 HT<br />
EYES HAIR<br />
S.S.II<br />
EMPLOYER<br />
BILL TO Y COST #<br />
/10<br />
WT<br />
ADDITIONAL DRIVER<br />
NO OTHER DRIVER PERMITTED<br />
PERMISSION TO LEAVE STATE<br />
YES NO X<br />
CUSTOMER SIGNATURE ON FILE<br />
PAYMENT INFORMATION<br />
AMOUNT PD. BY TYPE DATE AUTH<br />
CLOSED TICKET PAYMENT INFO<br />
CLOSED TICKET PAYMENT INFO<br />
SUMMARY OF CHARGES<br />
DAY = 24 HOUR PERIOD<br />
MILES<br />
NO CHARGE<br />
RENTAL AG;REEMENT<br />
,D270613<br />
PAGli:l OF 1<br />
1 DAYS @ 39.99 39.99<br />
VLF<br />
TOTAL CHARGES<br />
DEPOSITS<br />
REFUND<br />
BILL TO COST<br />
OPENED BY 11246FJ<br />
CLOSED BY 115255Y<br />
.20<br />
40.19<br />
40.19
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