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DIXIE FIRE INTAKE

Client Information

Name: Date:

Phone: Email:

DOB:

Impacted Address

Address: City:

State: Zipcode:

Current Mailing Address

Address: City:

State: Zipcode:

At the time of the fire you were:

Retainer

Homeowner

Occupant

Nature of Loss/Damage:

Personal Property

Agriculture

Real Property

Emotional Distress

Physical Injury

Wrongful Death

Insurance Coverage?

Yes

Insurance provider:

I acknowledge and understand that The Wagner Law Group are not my attorney and have not undertaken my legal representation until The Wagner Law Group acknowledge that they are my attorneys in writing. I further understand that this form is not legally binding.

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

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Timestamp

Audit

August 23, 2021 3:14 pm PDT

DIXIE FIRE INTAKE Uploaded by Rhonda Beckham - rbeckham@wagnerjones.com IP 104.174.140.255

August 23, 2021 3:44 pm PDT

Document owner info@wagnerjones.com has handed over this document to rbeckham@wagnerjones.com 2021-08-23 15:44:30 - 76.227.233.246

August 23, 2021 5:04 pm PDT

Rhonda Beckham - rbeckham@wagnerjones.com added by Rhonda Beckham - rbeckham@wagnerjones.com as a CC'd Recipient Ip: 98.41.118.124

August 23, 2021 5:04 pm PDT

Steve Amaro - samaro@wagnerjones.com added by Rhonda Beckham - rbeckham@wagnerjones.com as a CC'd Recipient Ip: 98.41.118.124

August 23, 2021 5:04 pm PDT

Jake Benjamin - jbenjamin@wagnerjones.com added by Rhonda Beckham - rbeckham@wagnerjones.com as a CC'd Recipient Ip: 98.41.118.124

August 23, 2021 5:04 pm PDT

Butch Wagner - bwagner@wagnerjones.com added by Rhonda Beckham - rbeckham@wagnerjones.com as a CC'd Recipient Ip: 98.41.118.124

August 23, 2021 5:04 pm PDT

Aaron Benjamin - abenjamin@wagnerjones.com added by Rhonda Beckham - rbeckham@wagnerjones.com as a CC'd Recipient Ip: 98.41.118.124

January 27, 2022 3:55 pm PDT

Rhonda Beckham - rbeckham@wagnerjones.com added by Rhonda Beckham - rbeckham@wagnerjones.com as a CC'd Recipient Ip: 71.195.187.98

January 27, 2022 3:55 pm PDT

Jody Jones - jody@www.wagnerjones.com added by Rhonda Beckham - rbeckham@wagnerjones.com as a CC'd Recipient Ip: 71.195.187.98

January 27, 2022 3:55 pm PDT

Jake Benjamin - jbenjamin@wagnerjones.com added by Rhonda Beckham - rbeckham@wagnerjones.com as a CC'd Recipient Ip: 71.195.187.98

January 27, 2022 3:55 pm PDT

Butch Wagner - bwagner@wagnerjones.com added by Rhonda Beckham - rbeckham@wagnerjones.com as a CC'd Recipient Ip: 71.195.187.98

January 27, 2022 3:55 pm PDT

Aaron Benjamin - abenjamin@wagnerjones.com added by Rhonda Beckham - rbeckham@wagnerjones.com as a CC'd Recipient Ip: 71.195.187.98

May 16, 2023 11:04 am PDT

Rhonda Beckham - rbeckham@wagnerjones.com added by Rhonda Beckham - rbeckham@wagnerjones.com as a CC'd Recipient Ip: 104.174.140.255

May 16, 2023 11:04 am PDT

Sydney Firstman - sydney@www.wagnerjones.com added by Rhonda Beckham - rbeckham@wagnerjones.com as a CC'd Recipient Ip: 104.174.140.255

May 16, 2023 11:04 am PDT

Jake Benjamin - jbenjamin@wagnerjones.com added by Rhonda Beckham - rbeckham@wagnerjones.com as a CC'd Recipient Ip: 104.174.140.255

May 16, 2023 11:04 am PDT

Butch Wagner - bwagner@wagnerjones.com added by Rhonda Beckham - rbeckham@wagnerjones.com as a CC'd Recipient Ip: 104.174.140.255

May 16, 2023 11:04 am PDT

Aaron Benjamin - abenjamin@wagnerjones.com added by Rhonda Beckham - rbeckham@wagnerjones.com as a CC'd Recipient Ip: 104.174.140.255

May 16, 2023 11:04 am PDT

Liz TWLG - liz@www.wagnerjones.com added by Rhonda Beckham - rbeckham@wagnerjones.com as a CC'd Recipient Ip: 104.174.140.255