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Re:                   My Client:                   CLIENT NAME 

                        Your Insured:                        INSURED NAME

                        Your Policy Number:            POLICY NUMBER

                        Date of Loss:              DATE OF LOSS

Dear Sir/Madam:

This office has been retained to represent the above-named in his claim for damages against your insured for personal injuries sustained as a result of the negligence of your insured on the above date of loss at or near the intersection of Chippewa and Gravois in the City of St. Louis.

Our employment is by contingent contract under provision of R.S.Mo. §484.140 and we hereby claim a lien with regard to any and all monies or other consideration recovered from you, or others on your behalf, as a result of settlement, lawsuit or other methods.

A copy of the police report regarding the crash is enclosed herewith


Thank you for your courtesy in this matter