Item: [lblItem]
[lblAddtlItemDescr]
Damage Description: [lblDamage]
[lblAddtlDamageDescr]
Packed By: [lblPackedBy]
Inventory #: [lblInvNbr] Date Purchased: [lblDatePurchased]
Original Cost: [lblOriginalCost] Replacement Cost: [lblReplacementCost]
Amount Claimed or Repair: [lblAmtClmdRepair]