| Contact Information | |
|---|---|
| First Name | Leah |
| Last Name | Botma |
| Address | 22742 W Yavapai St |
| City | Buckeye |
| State | AZ |
| Province | |
| Zip/Postal Code | 85326 |
| Country | United States |
| Work Phone | n/a - |
| Fax | n/a |
| lejabot83@yahoo.com | |
| Alternate Email | n/a |
| Website Address | n/a |
| Gender | Female |
| Injury Information | |
| The injured person is | Self |
| Name of Injured | Leah - Botma |
| Date of Injury | 01/19/2008 |
| Type of Injury | Traumatic |