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Date of fire (M/DD/YYYY):  FORMTEXT       Owner of property that burned:  FORMTEXT       Occupant of property that burned:  FORMTEXT       Location of fire (street address, preferably, or directions):  FORMTEXT       City where fire occurred:  FORMTEXT       County where fire occurred:  FORMTEXT        Your name:  FORMTEXT       Company:  FORMTEXT       Mailing address:  FORMTEXT       City  FORMTEXT      State  FORMTEXT NEZip Code  FORMTEXT       -  FORMTEXT     Phoz    ' ( 4 5 6 @ A  N P R f h j t v | f h j ~ 汫汫汫t汫j hUSCCJUjhUSCCJUjhUSCCJUmHnHujhUSCCJU hUSCCJjhUSCCJU hUSCCJ hUSC5\ hUSCCJjhUSCUmHnHuhUSCB* CJphhUSChUSCB* ph3fhUSC5B* CJ\ph3f)Jz     x z [kd$$IflP$$04 lal$If$a$ ''z | A[kd$$IflP$$04 lal$If[kd$$IflP$$04 lal~ 468LNPZ\bdfz|~ ǺǭԟǒDžjhUSCCJUjrhUSCCJUjhUSCUmHnHujShUSCCJUjBhUSCCJU hUSCCJ hUSC5\hUSCjhUSCCJUmHnHujhUSCCJUj1hUSCCJU/ ^`A[kd$$IflP$$04 lal$If[kd$$IflP$$04 lal`bf6`kd$$IflP$%04 laT $If^[kd$$IflP$$04 lal0243`kd $$IflP$%04 laT`kd $$IflP$%04 laT $If^ ",.4<>@TVXbdfprt$$$ $ǺǭǕLjԁ{qjh:CJUh:U h:5\j hUSCCJUj hUSCCJUhUSCCJmHnHuj hUSCCJUj hUSCCJU hUSCCJ hUSC5\hUSCjhUSCCJUmHnHujhUSCCJUjhUSCCJU,4f|$$^kd $$IflPFc$ 0    4 laT$If O$If^O $If^ne ( FORMTEXT    )  FORMTEXT     -  FORMTEXT     Date of Request  FORMTEXT      Reason for request  FORMTEXT         OFFICE USE ONLY: Fire/IR #: _____________ DNI  FORMCHECKBOX  No FD Report  FORMCHECKBOX   Mail: Nebraska State Fire Marshal s Office Fax: (402) 471-3118 Email:  HYPERLINK "mailto:nicki.dixon@sfm.ne.gov" nicki.dixon@sfm.ne.gov 246 S 14th St Lincoln, NE 68508-1804 $$ $"$($*$.$0$D$F$H$N$P$V$X$l$n$p$x$z$|$$$$$$$$$$$$$%%%㵭vpcvjhUSCCJU hUSCCJjhUSCCJU hUSC5\jh:UmHnHuj h:Ujh:U h:5h:h:5h:j0 h:CJUj h:CJUjh:CJUmHnHujh:CJUjD h:CJU h:CJ#$$%%%% %"%$%&%}}s}s}ss $If^ _ $If^skd,$$IflP0X$p04 laT %%%(%*%,%.%0%%%%%%%%%%%%%%&&&\&n&t&z&&&&&& '''&'ȿ{k`h5+h5+0JCJjh5+hu-CJU h5+CJjh5+CJU hUSC5\j\hUSC5CJU\jhUSC5CJU\jhUSC5CJU\hUSC5CJ\ hUSCCJ hUSCCJjhUSCUmHnHuhUSCjhUSCCJUjhUSCCJUmHnHu$&%(%,%0%%%&&@'p'''''`kdU$$Ifl$%04 laT &'<'>'T'd'h''''' hUSCCJ hUSCCJH* hUSCCJhUSCjh5+CJUh5+hUSC0JCJ ,1A/ =!"8#8$8% D Text1M/d/yyyy$$Ifl!vh5$#v$:V lP0,5$4alD(Text2 UPPERCASE$$Ifl!vh5$#v$:V lP0,5$4alD(Text3 UPPERCASE$$Ifl!vh5$#v$:V lP0,5$4alD(Text4 UPPERCASE$$Ifl!vh5$#v$:V lP0,5$4alDText5 UPPERCASE$$Ifl!vh5$#v$:V lP0,5$4alDText6 UPPERCASE$$Ifl!vh5$#v$:V lP0,5$/ 4alD(Text7 UPPERCASE$$IfT!vh5%#v%:V lP0,5%4aTD(Text8 UPPERCASE$$IfT!vh5%#v%:V lP0,5%4aTD(Text9 UPPERCASE$$IfT!vh5%#v%:V lP0,5%4aTvDText10DText11NE UPPERCASEvDText12vDText15$$IfT!vh555 #v#v#v :V lP0555 4aTvDText13vDText16vDText17D Text18M/d/yyyy$$IfT!vh5p5#vp#v:V lP0,5p54aTDText14 UPPERCASE$$IfT!vh5%#v%:V l05%/ 4aTtDeCheck1tDeCheck2DyK yK <mailto:nicki.dixon@sfm.ne.govD@D NormalOJQJ^J_HmH sH tH D@D Heading 1$$@&a$ 5CJ\DA@D Default Paragraph FontVi@V  Table Normal :V 44 la (k(No List 6U@6 Hyperlink >*B*ph  2%=UVIJK~   ?@Aqrsu >??@BE!0@0@0@0=@0=@0=@0=@0= @0= @0=@0= @0= @0=@0= @0= @0=@0= @0= @0=@0= @0= @0=@0= @0= @0=@0=@0= @0= @0=@0= @0= @0=@0= @0= @0= @0= @0= @0= 0= 0= 0= 0=0=0=0=0=0=0=0= 0= @0=@0=@0=@0=@0=@0=0@0=0=0~  $%&'' z `4$&%' ' 5AGjv|&28]io !'+7<FRVYeimy~ -= FFFFFFFFFFFFFFFFFFG$G$Xf  0e0e     A@ A5% 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E||S"@~(  TB  c $D)TB  c $D)TB  c $D)TB  c $D)t  6 ? 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