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OPERATCR'S REPORT OF BE FILLED OUT BY THE GOVERNMENT YOUR OWH WAY NOW TIME AND AT THE SCENE OF THE CCIDENT,INSOFAR AS POSSIBLE. MOTOR-VEHICLE ACCIDEN Without a split second of warning a figure lunged from the CEPARTMENT CR AGENCY U.S. Dep't. of Justice, Immigration & Naturalization Svc darkness on the left, immediately in path of automobile, RAME AND LOCATION OF ORGANIZATION TO WHICH YOU ARE ASSIGNED 9073 Southwest Regional Office, Terminal Island,: San Pedro, Same instant he was struck. PLEASE PRINT FULL NAME RANKRANGC / CARTER, Harlon B. IReg.Cc SERVICE NUMDER OR ROSTER TITLE OPERATORS STATE PERMIT NU Regional Commissioner K387.286 (Ca HOME ADDRESS Sreciy.Stale 92640 TELEH 12331 Oakwood Street, Garden Grove, Cal./ 714/534 DATE AND DAY CF W/EEK OF ACCIDEN HOURA.M.rP.M 4 Sunday, 5/10/70 12:05 a.m. PLACE OF AccDENT I accidnt in ciy.ie ciy cnd State oudo cily limisinio e o ncarcs e or other lend PLACE On Riverside Fwy. in Riverside, Calif.,. between Jackson and Van Buren - FROM WHAT PLACE TO WHAT PLACE WERE YOU BOUND El Paso/Tucson to Garden Grove, Calif.. FOR WHAT PURPOSE Returning to residence on official business. end of detail MAK3 C531*0822 REGISTRATIONMUMDER C Chevrolet 90A 373 PARTS OF VEHICLE.DAMAGED Dcrib Grill broken; hood and fender bent -10- : YOOR MAKE TYPE YEAR No other OPERATOR'S STATE PERMIT NUMBER i VEHICLE LICENSE NUMDER OPERATED BY (Nam YEMICLE OWNED BY OPERATORS HOM ADDRESS (Sireciy.State OWNERS ADDRESSStrtcy.Sta PARTS OFVEHICLE DAMAGEDDC OTHER VEHICLEOR PROPERTY DAMAGEDDesCr DATE 5/11/70 TFY AS POSSIBL Standard Form.91 CirculnrA-5 Re