| Contact Information | |
|---|---|
| First Name | Connie |
| Last Name | Burt |
| Address | 1002 Silverbow Ave. |
| City | Belgrade |
| State | MT |
| Province | |
| Zip/Postal Code | 59714 |
| Country | United States |
| Home Phone | 406 - 388-0916 |
| Work Phone | - |
| Fax | |
| clb1125@msn.com | |
| Alternate Email | |
| Website Address | |
| Gender | Female |
| Injury Information | |
| The injured person is | Child |
| Name of Injured | Andrew - Burt |
| Date of Injury | 01/20/2000 |
| Type of Injury | Obstetric |