| Contact Information | |
|---|---|
| First Name | Joe |
| Last Name | Alsbury |
| Address | 312 N. Cedar St. |
| City | Gardner |
| State | IL |
| Province | |
| Zip/Postal Code | 60424 |
| Country | United States |
| Home Phone | 815 - 409-6162 |
| Work Phone | - |
| Fax | 815-2378496 |
| Alsbury1124@hotmail.com | |
| Alternate Email | |
| Website Address | |
| Gender | Male |
| Injury Information | |
| The injured person is | Self |
| Name of Injured | Joe - Alsbury |
| Date of Injury | 06/23/2000 |
| Type of Injury | Traumatic |