| Contact Information | |
|---|---|
| First Name | jason |
| Last Name | hale |
| Address | 14 mountain view drive goonellabah |
| City | lismore |
| State | |
| Province | lismore |
| Zip/Postal Code | 2480 |
| Country | -- |
| Home Phone | 02 6 - |
| Work Phone | 0401 - |
| Fax | |
| tobsy15@hotmail.com | |
| Alternate Email | |
| Website Address | |
| Gender | Male |
| Injury Information | |
| The injured person is | Self |
| Name of Injured | jason - hale |
| Date of Injury | 12,1,2002 |
| Type of Injury | Traumatic |