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nsurance Connector, unless waived from the health insurance requirement based on affordability or individual hardship. For more information call the Connector at 1-877-MA-ENROLL or visit the Connector website (www.mahealthconnector.orq). This plan Is not intended to provide comprehensive health care coverag

THOMAS CYRIL E N.Y. NEWARK INTL A UA N/A YY 00 N/A YY 00 N/A YY 00 Ticket Number: 01670903543131 Date of Departure:07/21 Passenger Name:DERBY/FRANCIS Document Type: PASSENGER TICKET 07/14/12 ORBITZ MANKATO MN $270.60 AMERICAN AIRUNES INC From: To: Carrier: Class: NEW YORK LA GUARD! DAL

nsurance Connector, unless waived from the health insurance requirement based on affordability or individual hardship. For more information call the Connector at 1-877-MA-ENROLL or visit the Connector website (www.mahealthconnector.orq). This plan is not intended to provide comprehensive health care coverag

LUE AIRWAYS CORPORATI From: To: ST THOMAS CYRIL E SAN JUAN LUIS MUNO N.Y.1 F KENNEDY I N/A N/A Ticket Number: 27970907179106 Passenger Name: DERBY/FRANCIS Document Type: PASSENGER TICKET Carrier. Class: B6 B6 YY 00 YY 00 Date of Departure: 07/19 $2,040.66 55.66 $30.00 5585.70 Continued on

nsurance Connector, unless waived from the health insurance requirement based on affordability or individual hardship. For more Information call the Connector at 1-871-MA-ENROLL or visit the Connector webslte (ynvw.mahealthconnector.org). This plan rs not intended to provide comprehensive health care covera

F KENNEDY I ST THOMAS CYRIL E AA V N/A YY 00 N/A YY 00 N/A YY 00 Ticket Number 00170188252566 Date of Departure: 05/01 Passenger Name: DERBY/FRANCIS Document Type: PASSENGER TICKET 04/22/12 ORBITZ MANKATO MN AMERICAN AIRLINES INC From: To•. Carrier. Class: N.Y. IF KENNEDY I ST THOMAS O