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EFTA Document EFTA01316595EFTA Document EFTA01316597
Case File
sd-10-EFTA01316596Dept. of JusticeOther

EFTA Document EFTA01316596

CONFIDENTIAL hJ Case o5-31.08 itrbptrflj QC' I Ote'tL\ TO - DISTRICT: 0000050 PALM BEACH GRADE LEVEL: 12 PREPARED DATE: 01/ FL STUDENT ID: 591660245X SSN: 59: LEGAL NAME: MAILING PARENT/GUARDIAN (NAME/CODE): TERESE HALL-GOLICK PARENT IMMUNIZATION STATUS: PERMANENT INNUNI:ATI2N VACCINE STATUS, DATE - TYPE DOSE DATE DOSE DATE DTP 1 03/04/1987 2 05/1 4'1". POLIO 1 03/04/1987 2 05/1 1 ' 4'' HIE 1 04/02/1990 Nom, 1 07 b,:,:,,; • 10' RO ALIAS: 591‘6024SX RACIAL/ET B

Date
Unknown
Source
Dept. of Justice
Reference
sd-10-EFTA01316596
Pages
1
Persons
0
Integrity
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Summary

CONFIDENTIAL hJ Case o5-31.08 itrbptrflj QC' I Ote'tL\ TO - DISTRICT: 0000050 PALM BEACH GRADE LEVEL: 12 PREPARED DATE: 01/ FL STUDENT ID: 591660245X SSN: 59: LEGAL NAME: MAILING PARENT/GUARDIAN (NAME/CODE): TERESE HALL-GOLICK PARENT IMMUNIZATION STATUS: PERMANENT INNUNI:ATI2N VACCINE STATUS, DATE - TYPE DOSE DATE DOSE DATE DTP 1 03/04/1987 2 05/1 4'1". POLIO 1 03/04/1987 2 05/1 1 ' 4'' HIE 1 04/02/1990 Nom, 1 07 b,:,:,,; • 10' RO ALIAS: 591‘6024SX RACIAL/ET B

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EFTA Disclosure
Text extracted via OCR from the original document. May contain errors from the scanning process.
CONFIDENTIAL hJ Case o5-31.08 itrbptrflj QC' I Ote'tL\ TO - DISTRICT: 0000050 PALM BEACH GRADE LEVEL: 12 PREPARED DATE: 01/ FL STUDENT ID: 591660245X SSN: 59: LEGAL NAME: MAILING PARENT/GUARDIAN (NAME/CODE): TERESE HALL-GOLICK PARENT IMMUNIZATION STATUS: PERMANENT INNUNI:ATI2N VACCINE STATUS, DATE - TYPE DOSE DATE DOSE DATE DTP 1 03/04/1987 2 05/1 4'1". POLIO 1 03/04/1987 2 05/1 1 ' 4'' HIE 1 04/02/1990 Nom, 1 07 • 10' RO ALIAS: 591‘6024SX RACIAL/ET BIRTH DAT BI RTHPLAC CERTIFICATE VACCINE CERTIFICATE $ DOSE DATE COSE D$ 08/01/1987 4 01 08/01/1987 4 SDNY_GM_00344732 EFTA 0(1217425 EFTA01316596

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