| Contact Information | |
|---|---|
| First Name | marvin |
| Last Name | kruth |
| Address | 58 lester drive |
| City | orangeburg |
| State | NY |
| Province | |
| Zip/Postal Code | 10962 |
| Country | United States |
| Home Phone | 845 - 359-5376 |
| Work Phone | na - |
| Fax | na |
| marvin kruth@optonline.net | |
| Alternate Email | |
| Website Address | |
| Gender | Male |
| Injury Information | |
| The injured person is | Self |
| Name of Injured | marvin - kruth |
| Date of Injury | 05/34/06 |
| Type of Injury | Traumatic |