Fire Start Date: Fire Start Time: IC S Name s1
STATE OF NEW MEXICO
Energy, Minerals and Natural Resources Department
Forestry Division
FIRE DEPARTMENT
REIMBURSEMENT REQUEST / Fire Number
Fire Name
Fire Department
INCIDENT DETAILS:
Fire Start Date: Fire Start Time: IC’s Name:
County:
Ownership: PrivateStateFederalOther PublicUnknown
Forest Cover Type:
Fuel Type– (what actually burned):
General Cause: Other
Structures Threatened Number and Type:
Number of Structures Burned:
Fire Location: T.R.Section1/4Section
and/or Latitude Longitude
Acreage Burned by Land Ownership: (number of acres in blanks)
BIA BLM FWS NPS Private State USFS Other (specify)
Dispatch: Date Time Acres
Initial Attack: Date Time Acres
Controlled: Date Time Acres
Back To Station: Date Time Acres
Slope at Origin: 0-00-2526-4041-5556-7576-200
Aspect at Origin:
Temperature:(°F) RH:% Wind Speed: Wind Direction:
Fire Behavior on Initial Attack:
FORM COMPLETED BY TITLE DATE/
STATE OF NEW MEXICO
Energy, Minerals and Natural Resources DepartmentForestry Division
FIRE DEPARTMENT
REIMBURSEMENT REQUEST
/ FIRE NUMBER:
FIRE NAME:
Equipment
Equipment Description / License Number / # of Hours / *Rate per Hour / Total
1 / 0
2 / 0
3 / 0
4 / 0
5 / 0
6 / 0
7 / 0
8 / 0
9 / 0
10 / 0
11 / 0
12 / 0
Make Reimbursement Payable to: / Total Reimbursement / 0
Name: CATRON COUNTY
for
Address: PO BOX 407 / Vendor No.: 0000054377
City: RESERVE / State: NM / Zip Code: 87830
*Use current equipment rate schedule
**Checks are made payable to the governing
body or fiscal agent of fire department. / DIVISION APPROVAL / ü
District Forester Date