Confidential Notes

It is hereby noted that the claimant's cat has a history of setting off the fire alarm at 3am on Tuesdays.

Further notes: The claimant's neighbor has it out for the claimant's lawn gnomes.

The claimant's favorite food is ramen noodles.

Relevant Attachments:

• Attachment 1: Medical Records
• Attachment 2: Police Report
• Attachment 3: Claimant's Cat's Medical Certificate

Claimant's signature:

Agent's signature:

Claims Adjuster's Notes:

This claim is still pending due to lack of evidence that the claimant's cat did not set off the fire alarm on purpose.

Further investigation is needed.