| Contact Information | |
|---|---|
| First Name | William |
| Last Name | Stott |
| Address | 641 Highpark Lane |
| City | Raleigh |
| State | NC |
| Province | |
| Zip/Postal Code | 27608 |
| Country | United States |
| Home Phone | 919 - 9908977 |
| Work Phone | 919 - 9908977 |
| Fax | |
| Gender | Male |
| Injury Information | |
| The injured person is | Self |
| Name of Injured | William - Stott |
| Date of Injury | 10/01/1997 |
| Type of Injury | Traumatic |