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