| Contact Information | |
|---|---|
| First Name | Tim D |
| Last Name | Johnson |
| Address | 12183 Great River Rd |
| City | Little Falls |
| State | MN |
| Province | |
| Zip/Postal Code | 56345 |
| Country | United States |
| Home Phone | 320 - 632-1075 |
| triver56@hotmail.com | |
| Alternate Email | |
| Website Address | |
| Gender | Male |
| Injury Information | |
| The injured person is | Self |
| Name of Injured | Tim D - Johnson |
| Date of Injury | 03/31/1976 |
| Type of Injury | Traumatic |