10 ANNUAL REPORT OF 



STATE OF MINNESOTA. 

 FIRE WARDEN'S REPORT OF FIRE. 

 To the Forestry Commissioner, St, Paul, Minn.: 



A [state whether forest, prairie or field fire] 



fire occurred in the [state what part of town] 



part of the town of being Township No 



Range in the County of on the 



day of [state about what time of 



day] It burnt over; acres of [state 



kind of land, whether field, prairie, brush, meadow, heavy or light 



timber] destroyed 



and did damage to the amount of 



$ Said fire originated on Section No 



being land occupied by [if vacant, 



so state] and was caused by [explain 



how it originated. It is the chairman's duty "to inquire into the 

 cause" of the fire. He should report the facts and circumstances 

 showing who caused the tire] 



The fire was extinguished in hours after it started. There 



were persons called to help extinguish it. [If 



none were called, so state.] The number of persons assisting in 



extinguishing the fire was The fire was 



extinguished in the following manner 



The weather was [state whether dry and windy andhow long it had 

 been dry] 



[Give the name of any Fire Warden who was present and assisted 

 in controlling or extinguishing the fire, and the name and address 

 of any witness as to who set the fire and state what he will 

 swear to. 



P. O Signature..,, 



Date Name of Organized Township. 



