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Home My WebLink About971299.tiffRESOLUTION RE: AUTHORIZATION FOR THE WELD COUNTY ATTORNEY TO PROCEED WITH LEGAL ACTION AGAINST JAN AND BARBARA BUTLER FOR VIOLATION OF THE WELD COUNTY ZONING ORDINANCE WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, Jan and Barbara Butler, VI #9700090, are allegedly in violation of the Weld County Zoning Ordinance, and WHEREAS, despite efforts by the Planning staff to resolve said matter, the violation has not been corrected, and WHEREAS, on the 8th day of July, 1997, a public hearing was held before the Board of County Commissioners for the purpose of hearing testimony relating to said violation, and WHEREAS, Joseph Butler represented the property owners at said hearing, and WHEREAS, the Board of County Commissioners deems it advisable to refer said violation to the Weld County Attorney's Office for legal action, with an instruction for delay of action upon such referral until September 8, 1997, to allow adequate time for the property owners to bring the subject property into compliance and for an inspection of the property by the Department of Planning Services staff. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that said violation be, and hereby is, referred to the Weld County Attorney's Office for legal action against Jan and Barbara Butler to remedy the violation of the Weld County Zoning Ordinance, and any other persons occupying the properties, any persons claiming an interest in the properties, and any persons acting in active concert with the identified parties, with an instruction for delay of action upon such referral until September 8, 1997, to allow adequate time for the property owners to bring the subject property into compliance. 971299 Cc: A;CfrJ PL0824 VI #9700090 - BUTLER PAGE 2 The above and foregoing Resolution was, on motion duly made and seconded, adeopted by the following vote on the 8th day of July, A.D., 1997. ATTE Weld BY: APP Deputy Clerk to e Board AS TO FORM: ounty Attor Dale K. Hall BOARD OF COUNTY COMMISSIONERS �RS WELD C�i1NTY, COLOR�4D0 ��✓"t .Baxt George E er, Chair EXCUSED DATE OF SIGNING (AYE) tance L. Harbert, Pro�Tem EXCUSED DATE OF SIGNING (AYE) Barbara J. Kirkmeyer,.. U / W. H. Webster 971299 PL0824 (0041 DATE: July 8, 1997 VIOLATION NUMBER: VI -9700090 NAME: Jan and Barbara Butler ADDRESS: 410 N. 66th Avenue, Greeley, CO 80634 LEGAL DESCRIPTION: Lot 2, JB Acres, 2nd Filing, Weld County, Colorado PARCEL NUMBER: 080533301004 CASE SUMMARY: April 25, 1997 May 14, 1997 May 15, 1997 May 15, 1997 June 20, 1997 Initial complaint received and referred to Julie Chester, Zoning Compliance Officer. Initial inspection of the property. Property is not in compliance. A note was left at the property. Telephone conversation with Joseph Butler, son of property owners. Thirty day Zoning Violation Notice sent to the property owners. Progress inspection of the property. Property is still not in compliance. June 24, 1997 Letter sent to the property owners indicating that the violation case was scheduled before the Board of County Commissioners. The noncommercial junkyard is still located on the property, therefore is a violation of Sections 31.2 and 31.3.9 of the Weld County Zoning Ordinance. To bring the property into compliance the noncommercial junkyard must be removed from the property or screened from all adjacent properties and public rights of way. The Department of Planning Services also recommends that the County Attorney authorize legal action against any other persons occupying the properties, any persons claiming an interest in the properties, and any persons acting in active concert with the identified parties. 971299 adr, Wi�Yc June 24, 1997 Jan and Barbara Butler 410 N. 66th Avenue Greeley, CO 80634 DEPARTMENT OF PLANNING SERVICES PHONE (970) 353-6100, EXT.3540 FAX (970) 352-6312 WELD COUNTY ADMINISTRATIVE OFFICES 1400 N. 17TH AVENUE GREELEY, COLORADO 80631 Subject: VI -9700090 Legal Description: Lot 2, JB Acres, 2nd Filing, Weld County, Colorado Dear Mr. and Mrs. Butler: The property referenced above remains in violation of the Weld County Zoning Ordinance. I have scheduled a meeting with the Board of County Commissioners on July 8, 1997 at 10:00 a.m. to consider the violations occurring on the property. This meeting will take place in the County Commissioners' Hearing Room, first floor, Weld County Centennial Center, 915 Tenth Street, Greeley, Colorado. It is recommended that you or a representative be in attendance to answer any questions the Board of County Commissioners might have about the violations. The Department of Planning Services' staff will be recommending that the Board of County Commissioners authorize the County Attorney to proceed with legal action to remedy the violation. Our records indicate that you were made aware of the nature of the violation, the action necessary to correct the violation, and that you were given sufficient time to remedy the violation. If you have any questions concerning this matter, please call me. Sincerely, Julie Chester Zoning Compliance Officer pc: VI -9700090 971299 PERMITS Id: MISC120 Keyword: @ACTM User: JCHESTER Additional Notations for Inspection item: 00400 Permit No: VI -9700090 Owner: BUTLER JAN S 8 BARBARA A Status: ISSUED Address: 410 N 66 AV WEL Line 1 2 3 4 5 6 7 8 9 Insp. Date Text 06/20/97 06/20/97 06/20/97 06/20/97 06/20/97 06/20/97 06/20/97 06/20/97 06/20/97 JULIE CHESTER, ZONING COMPLIANCE OFFICER 06/24/97 Violation THE PROPERTY WAS INSPECTED TO DETERMINE COMPLIANCE WITH THE WELD COUNTY ZONING ORDINANCE, SECTIONS 31.2 AND 31.3.9. THE PROPERTY IS NOT IN COMPLIANCE AT THIS TIME. THERE IS STILL A NONCOMMERCIAL JUNKYARD LOCATED ON THE PROPERTY CONSISTING OF PILES OF USED BUILDING MATERIALS AND TREE LIMBS. TO BRING THE PROPERTY INTO COMPLIANCE THE NONCOMMERCIAL JUNK- YARD MUST BE REMOVED FROM THE PROPERTY OR SCREENED FROM ALL ADJACENT PROPERTIES AND PUBLIC RIGHTS OF WAY. t r Enter Option: A=Add, C=Change, D=Delete, I=Inspect Up/Down=Select, PgUp/PgDn(F2)=Page, F3=First 12, ESC=Exit Comment Added O.K. 971299 4*t WI�P� DEPARTMENT OF PLANNING SERVICES PHONE (303) 353-6100, EXT.3540 FAX (303) 352-6312 WELD COUNTY ADMINISTRATIVE OFFICES 1400 N. 17Th AVENUE GREELEY, COLORADO 80631 WELD COUNTY ZONING VIOLATION NOTICE May 15, 1997 Violation Number : VI -9700090 Jan and Barbara Butler 410 N. 66th Avenue Greeley, CO 80634 Legal Description : Lot 2, JB Acres, 2nd Filing, Weld County, Colorado The uses on the above described property are being considered as a zoning violation of Section 31.2 and 31.3.9 of the Weld County Zoning Ordinance. This is not a use allowed by right in the Agricultural zone district. The violation can be corrected by removing the used building materials from the property, cutting and stacking the used building materials as fire wood or screening it from all adjacent properties and public rights of way. All vehicles on the property must have current license plates and be in running condition or may be screened also. It is the intention of this office to assist and cooperate with you without imposing undue hardships; however, we have no discretion in this matter if you fail to correct this violation. You have 30 (Thirty) days from May 15, 1997 to correct this zoning violation. Failure to do so will result in this office scheduling the violation before the Board of County Commissioners to consider whether to refer the violation to the County Attorney's office for legal action. Any information you have that may help to resolve this matter will be helpful. This office is ready to be of any assistance in clarifying or answering questions concerning this matter. Please call or write the Department of Planning Services' office. Sincerely, Jul a Ch6ester Zoning Compliance Officer pc: VI -9700090 971299 /yY t ELEPHONE ❑ OFFICE NAME: ..e00nG.- ADDRESS: TYPE OF INQUIRY: ❑ MHZP ❑ ZPMH ❑ RE ❑ AMENDED RE ❑ SE ❑ AMENDED SE ❑ SITE PLAN REVIEW ❑ REZONING ❑ PUD SKETCH PLAN ❑ PUD DISTRICT ❑ PUD FINAL PLAT PERSONNEL ❑ Shani Eastin ❑ Chris Goranson ❑ David Sprague ❑ Dennis Renley ITEMS DISCUSSED: WELD COUNTY DEPARTMENT OF PLANNING SERVICES/BUILDINf.INSPECTION CITIZEN INQUIRY FORM 1400 N. 17TH AVENUE, GREELEY, CO 80631 PHONE: (970) 353-6100 EXT. 3540 FAX: (970) 352-6312 FIRST INQUIRY? _GI.4S O NO DATE: Ski 5 /9 3 3- 3`71,0 301- ,3zr6 / ❑ SKETCH PLAN ❑ PRELIMINARY PLAN ❑ FINAL PLAT ❑ RESUBDIVISION ❑ FHDP ❑ GHDP ❑ USR ❑ AMENDED USR ❑ USR MINING ❑ USR MAJOR FACILITY ❑ USR DISPOSAL SITE ❑ ❑ Gloria Dunn ❑ Todd Hodges ❑ Kerni Keithley ❑ Ed Stoner ❑ Johnny Roberts ❑ Jeff Reif ❑ Monica Daniels -Mika ❑ PHONE: PT' ❑ MINOR SUB SKETCH PLAN ❑ MINOR SUB FINAL PLAT ❑ ZONING ❑ ADDRESSING ❑ BUILDING PERMIT ❑ SETBACKS/OFFSETS ❑ HO.ME OCCUPATION D. -VIOLATION ❑ OTHER ie Chester ❑ Roger Vigil ❑ George Carroll �ne , a 61� v 4 %LG `� � a -tad f lil ‘,,co 0 n -e, Time Spent /r) /)Itivp citizen Staff Member's Initials 971299 WELD COUNTY PLANNING DEPARTMENT OWNER �j PROPERTY ADDRESS/LEGAL 41 O N t007V It/ REFERRAL NUMBER: ❑ I INSPECTED THE PROPERTY: Se' I STOPPED BY THE PROPERTY WITH THE FOLLOWING CONCERNS: _4?-Ol'.- (:j4.tai rvL G` ❑ INSPECTION REQUIRED. INSP IF YOU WISH TO SPEAK TO A ZONING INSPECTOR, CALL (970)-353-6100, EXT. #3521 E CAL FOR INSPECTIO 01-353-6100OC, EXT, #3521. 971299 PERMITS Id: MISC120 Keyword: AACT User: JCHESTER Additional Notations for Inspection item: 00400 Permit No: VI -9700090 Owner: BUTLER JAN S & BARBARA A Status: ISSUED Address: 410 N 66 AV WEL Line Text 1 THE PROPERTY WAS INSPECTED TO DETERMINE COMPLIANCE WITH THE 2 WELD COUNTY ZONING ORDINANCE, SECTIONS 31.2 AND 31.3.9. THE 3 PROPERTY IS NOT IN COMPLIANCE AT THIS TIME. THERE IS A NON - 4 COMMERCIAL JUNKYARD LOCATED ON THE PROPERTY CONSISTING OF 5 A DERELICT VEHICLE AND LOTS OF USED BUILDING MATERIALS. TO 6 BRING THE PROPERTY INTO COMPLIANCE THE NONCOMMERCIAL JUNK - 7 YARD MUST BE REMOVED FROM THE PROPERTY OR SCREENED FROM ALL 8 ADJACENT PROPERTIES AND PUBLIC RIGHTS OF WAY. 9 JULIE CHESTER, ZONING COMPLIANCE OFFICER 05/15/97 Violation Insp. Date 05/15/97 05/15/97 05/15/97 05/15/97 05/15/97 05/15/97 05/15/97 05/15/97 05/15/97 Enter Option: A=Add, C=Change, D=Delete, I=Inspect Up/Down=Select, PgUp/PgDn(F2)=Page, F3=First 12, ESC=Exit Comment Added O.K. 971299 Permit No VI -9700090 COMPLAINT DATA SHEET 05/15/97 Page: 1 11:29 Data: Full Description Description: COMPLAINT: NONCOMMERCIAL JUNKYARD ON PROPERTY Data: Process Tables Screen No: 01 Base Information Parcel No: 0805 33 301004 Owner: BUTLER JAN S & BARBARA A Status: Description: Location: Zoning Dist: App Type: ISSUED Written By: JAC Sec/Twn/Rng: 33 06 66 COMPLAINT: NONCOMMERCIAL JUNKYARD ON PR 410 N 66TH AVENUE, GREELEY AGRICULTURAL Permit Num: VI (BCV=BLDNG VIO, VI=ZONING VIO, WCV=WELD VIO mbcv + vi") Class Code: VI -2 noncommercial junkyard Complaint: 04/25/1997 Init: JAC 5 Day Letter: 00/00/0000 Init: Issued: 05/15/1997 Init: JAC 05/14/1997 Init: JAC 00/00/0000 00/00/0000 00/00/0000 Inspection: BCC Vio: Court: Closed BCV: NO VI: 00/00/0000 'nit: Init: Init: Init: Closed VI: 00/00/0000 Init: Screen No: 02 Zoning Information Parcel No :0805 33 301004 Legal Descr:2J8-2 L2 JB ACRES 2ND FILING X410 N66 AV% Owner Name :BUTLER JAN S & BARBARA A Date:00/00/0000 Verified: Setbacks N: S: E: W: Reg by Zoning Sec Twn Rng:33 06 66 Notes: Zoning Dist:AGRICULTURAL Acres .00 ** 1=Yes, 2=No, Legal Lot Prior to Zoning Yr ft 80 Acres Rec Exemption RE Sub Exemption SE Use Spec Review USR Planned Unit Dev PUD Subdivision S Change of Zone COZ 3=Appr/Cond Met, 4=Appr/Cond Not Met ** 1 Site Plan Review SPR 1 Board of Adjustment BOA 1 Non -Conforming Use NCU 1 Flood Hazard Dev FHDP 1 Geological Hazard GHP 1 Accessory Dwelling ZPAD 1 1 1 Violation VI Screen No: 03 Violation Letter Text Use this screen to add text to be merged with violation letters. For all letters - Dear... : For all letters - My Name: My Title: Permit Num: (include ',') 971299 Permit No VI -9700090 COMPLAINT DATA SHEET 05/15/97 Page: 2 11:29 Data: Process Tables Continued... Ordinance Section: For Case Summary - To bring property into compliance... Data: People OWNER BUTLER JAN S & BARBARA A 410 N 66 AVE GREELEY CO 80634 05/15/97 Data: Conditions Data: Comments Data: Inspections Item: 00404 TELEPHONE CALL Item: 00405 LETTER Item: 00400 SITE INSPECTION Item: 00406 OFFICE VISIT Dept: Division: Dept: Division: Dept: Division: Dept: Division: Data: Approvals Item: 00001 Building Department Dept: BUILDING Division: Item: 00002 Planning Department Dept: PLANNING Division: Data: Locks, Holds, Notices Data: Addresses 410 N 66 AV WEL 05/15/97 Data: Parcels 080533301004 / / 971293 PERMITS Id: ASSR100M Keyword: SPARC User: JCHESTER 05/15/97 Parcel General Information Maintenance ee6686E6EE22e2E2EE688686666222222eEEe2e886866e6M842e222e22222222E262688866666ef ❑ General Parcel Data Maint - Action: Update Record ° uaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaN o Parcel No: 0805 33 301004 Rg Ts Sec : 660633a ❑ ❑ ❑ Status: A Active Retired(Y/N) N 0 ❑ Street Address: 410 Dir: N St: 66 AV City: WEL ❑ O Situs Location: 410 N 66 AV WELD ❑ ❑ Legal Desc: 2JB-2 L2 JB ACRES 2ND FILING %410 N66 AV% 0 O Acres: 1.74 ❑ O X-COORD: ❑ Y-COORD: 0 ❑ Tax Rate Area: 0684 ❑ o Assr Use Code: 1369086 Assessed/Exempt: ❑ O Pub Owned(Y/N): N ❑ o Primary Owner: BUTLER JAN S & BARBARA A Phone: ❑ ❑ Mailing Addr: 410 N 66 AVE ❑ o GREELEY CO ❑ a Zip: 80634 0 ° Contract Owner: Percent/Ownership: .00 ° aeee6666eeeeee6666e6eee6eeeee6ee6ee66ee666eeeee6ee6ee6eeeeeee6eee6eeeee6ee6ee6eY <F7>Write Record, cF2>Allow Fractions, <ESC>Cancel P ERMITS Id: ASSR100D Keyword: SPARC User: JCHESTER 05/15/97 Parcel Legal Description Maintenance edeeeegeegeeeeeeeegedeeee666e6e2eeE28866622e622E62e226Eee2e2e62eee6eeeege886686£ ❑ Parcel Legal Description - Action: Update Page: 1 ° uaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaN a 2JB-2 L2 JB ACRES 2ND FILING %410 N66 AV% ❑ a a a a • ❑ a2eee2eee2e66e6Eeee2e886688626622662ee6e66Ee2eeeeee26e666eee2ee2eee6ee66e666666Y ° Parcel: 0805 33 301004 Use: 1369086 Owner: BUTLER JAN S & BARBARA A ❑ ° Situs: 410 N 66 AV WELD Acres: 1.740 0 Legal: 2JB-2 L2 JB ACRES 2ND FILING %410 N66 AV% ❑ ae6eeeeeeedeeeeee6eeeeeeeeeeeedeeeeee6eeg6eegeeee6egeeeeeeeeeegeegeeeeeeeeeeeeeY <F7>Update, <F2/PgDn>Next Page, cF3/PgUp>Prev Page, <ESC>Cancel P ERMITS Id: MISC301 Keyword: SPARC User: JCHESTER 05/15/97 User Defined Data Fields for Parcel No: 0805 33 301004 OaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaC ° Parcel No: 0805 33 301004 ° aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaai 971299 B 1148 REC 02090668 03/05/87 09:31 53.00 1/001 AH2O 10bb8 - 1' 1065 MARY ANN FEUERSTEIN CLERK S RECORDER WELD CO, CO s©_'Wariaiyy`Deed .P E THIS DEED Is a conveyance of the real properly described below. including any improvements and other appurtenances (the -property) Iron the individual(]). corporation (al. parinenNp(e), or other entily(ies) named below as GRANTOR to the individusi(z) or enllty(ies) named below as GRANTEE. The GRANTOR hereby sells and conveys the properly :o the GRANTEE and the GRANTOR warrants the title to the properly. except for (I) the lien of the general property taxes for the year of this deed. which the GRANTEE will pay (2) any *elements and rights-of-way]sown Of record (31 any patent reservation) and exceptions (4) any outstanding mineral interests shown of retard (Si any protective covenants and nalrictione shown of record. and (s) any additional matters shown below under 'Additional Warren. Exceptions The Specific Terme of This Deed Are: Grouse (One namely) and gacebl of residence. lithe spout* of Ifs@ Owner -grantor Is loimnq in this Deed to release heawseed rights. Identity grantor, as waband and wile I LEON OVERBECK 1104 24th Avenue Greeley, Colorado 80631 Grantee. (Gee nenesl and eedresalesl: stateant of Seen. including awaked* lead or street ntaneer. Is reeered.I JAN S. BUTLER and BARBARA A. BUTLER 410 N. 66th Avenue Greeley, Colorado 80634 Porn 01 Co•Ownershlp: IIf there ere Iwo or more pewees some Many will tie ceneldered lb MYaes lenetS euMes, ells messes m Minn tenancy' Of notes of Me Mme meaning are Mss N the epee Mtn) "In Joint Tenancy" Property Description: (Sock's county and ass.) Lot 2. J.B. ACRES. SECOND FILING. Weld County. Colorado. Property AaareMe: 410 N. 66th Avenue, Greeley, Colorado Coaeldernnon: Its aflame et a eels wen* le options Papaw co.iderean Ip in. deed sae peeumed tees PC emweyoneols identified M eon: in MY ate ew Cemeyeae M aMMM. MS Me unrendleealal Ninety Thousand Dollars and No/100the ($90,000.00) Maayaaone-Maatetonel III we ORANTOM Mesed,Mrsp,e,Ily Yuen,, Mewpeeeffye•Manwyl mOsnlaeeCe.MMMOMNTYS M reNnetetp let GMIITIfe des M M property. male en,te M O Wrialt e ) Additional Warranty 6aepllone: nnelude sees of Mal Wog semered and eater mates via eased Meet) [,tiled tin the Granter on Vahretary 77 le �L Crews ctmNe for Cerareeem PalowelOp er aeaaLa— mams of Wan*: Commence Partnership a AaeaMllpn ay fir Aiwa) ttnllllllllp,rr, 1 . °"t/,,•.� sT} D(F ©TM a•{`r4lees. p_ u ( •'}e p _ wfeeged before me his 7�/ Apyi OHI lII 20, 1987 OTAT� briars utnd"1 COUNTY OI - a The Mragpinq IPOINOient we ecamwleeged belae me MM "If of err i' some messesel atomism or if promo. it corpesnan. relnereaper aloomonoo. Hiatt Mondry Penn u plaMerae Ira eoosoro adlesreterys eseaunl eecnury of commune Or 1r pennons) of pot eseot or M eu*eMed memewlel a ealailiMl1 siamlymanimskors V Leon Overbook Owes 27th svm February ,to87 t tG7rA41Wele/ ONTO 9712b9 be mill my nand end official Me. My cemminlee leek** • lest UPOA TM LIOLL Mabel en On. ve,S.nrrl.v Oninr.nnwMl] *Wry Pablo NO. PO e8eAdditional USER DEFINED Assessor Parcel InformationoeeeeeeeeecScreen No: 016£ 0 ❑ Parent Parcel No ❑ ❑ Book No. 1148 ❑ ❑ Reception No. 02090668 ❑ ❑ Document Type ❑ ❑ Ownership Type ❑ ❑ Recording Date 03/05/1987 Mar 05, 1987 ❑ ❑ Zoning Dist ❑ ❑ Legal Lot ❑ ❑ Prior To Zoning ❑ ❑ Prior To Zoning Year ❑ ❑ > 80 Acres ❑ ❑ Recorded Exemption ❑ ❑ Rec Exemption Permit ❑ ❑ Rec Exemption Approv ❑ aeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeY <F7>Update, <ESC>Cancel 97129 WIt9c COLORADO DEPARTMENT OF PLANNING SERVICES COMPLAINT REPORT p -ZONING COMPLAINT Complaint Initiated by: o BUILDING CODE COMPLAINT o Staff ,.a'Eitizen o Other LEGAL DESCRIPTION: VIOLATION ADDRESS: Parcel # AY ;/9,696h-wo idet-d7e5 r05- 33 30 /COI/ ATTACH COPY OF DEED Property Owner's Name: "T/ 0 Afre Property Owners Address: Tenant's Name and Mailing Address: AJtA CJ c NATURE OF COMPLAINT: (/ J li-e-k / ne--3 (lya-c _1 L-tLi r� /99 a (A Zoning Complaint Referred To: Building Code Complaint Referred T Case Assigned To: ACTION OF INVESTIGATOR: Inspection of property indicates: A 2-0 Date: Date: Date: Dale of Inspection: b / 17 19 7 o No violation of the Weld County o Zoning / a Building Code Ordinance Referred to: on o No olation of the Weld County ❑ Zoning / ❑ uilding Code Ordinance ❑ iolations of the following Sections of th onin j , Y 1 3) • 5 9 o Building Code Ordinance ACTION ON COMPLAINT: a No Action Taken/No Violation o>Rolation FileiStartgd9 Date Date S// TT // CASE REVIEWED BY SUPERVISOR SUPERVISOR'S COMMENTS NOTE: Attach all pertinent information and facts disclosed by investigation to this form. Date 371293 Hello