Name _______________________________________________________________________

    Address _____________________________________________________________________

    City __________________________ State ___________________ Zip Code _______________

    Telephone ____________________________ Email ____________________________________

    Information being submitted
    Please describe the information for which you wish to obtain a case number:
    Please submit only photographic representations of material objects!
    Please submit complete descriptions of the particular case you are investigating.
    Include time, date, persons involved, location etc...:

    Are you the principal investigator (circle one)   YES      NO
    Do you certify that you are the rightful owner of any evidence that is being submitted (circle one)   YES     NO
    Do you certify that all information submitted by you is true (circle one)   YES    NO
    I swear that I am responsible for any misrepresentation of material/information submitted to the IFRS Repository.
    I hold the IFRS blameless and understand that any legal repercussion of my falsification is solely mine.
    I submit this information in good faith under the prevailing laws of the UNITED STATES, its' subject states and
    municipalities. I understand that the IFRS honors all applicable laws.

    ____________________________________________________                Date_____________________
                                            (Signature)

Your case number is ________________________________________________.

Signed ___________________________________________________________
                                                            Director