Contact Information
First Name	Elida
Last Name	Estrada
Address	1502 Pintail st.
City	Laredo
State	TX
Province
Zip/Postal Code	78045
Country	United States
Gender	Female
Injury Information
The injured person is	Self
Name of Injured	Elida - Estrada
Date of Injury	10/14/2012
Type of Injury	Traumatic