Epstein Secrets

El Other This page has been updated OV DATE: 4a97 a5- BY: DATE: PBSD 0269 (REV. 1/88) EFTA01709618 FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: FLORIDA STATUTES 232.032, s. 10D-3.088, F.A.C. and s. 10M-12, F.A.C. LAST NAME PARENT OR GUARDIAN FIRST MI DOB MCYDAAR Child's SS# (optional)

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Retain Mr Indicate: Promote (P) Retain (R) - Indicate: Promote (P) Retain (A) 01-93d0 EFTA01709793 FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: FLORIDA STATUTES 232.032, s. 64D-3.011, F.A.0 and s. 65C-22.006, F.A.C. LAST NAME J PARENT OR GUARDIAN D i r e t t i o n C • Enter all appropri

andards la. Yon elèv ki nan 5yelim Nivo reponn pifb kesyon egzamen yo kbrekteman, elèv la menm reponn kesyon ki gen pi plis difikilte ladan yo. 4 Elèv sa a gen siksè nan matyè ki te gen difikilte laden yo nan egzamen Sunshine State Standards la. Yon elèv ki nan 4yèrn Nivo reponn pifb kesyon egzamen y

be between 1750 and 1856. NT-Not Tested NR-Not Reported Data Run Date: 11/22/2004 0115263 EFTA01710024 FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: FLORIDA STATUTES 232.032,8.64D-3.011, F.A.0 ands. 65C-22.00C F.A.C. FIRST Child'sSW (optional) MIAR IM DO MO/DA/YR STATEIMMUNIZATION ID#' Dire

Standards la. Yon elèv ki nan 5yèm Nivo reponn pifb kesyon egzamen yo kbrèkteman, elèv la menm reponn kesyon kl gen pi plis difikilte ladan yo. 4 Elèv sa a gen siksè nan matyè ki te gen difikilte ladan yo nan egzamen Sunshine State Standards la. Yon elèv ki nan 4yèm Nivo reponn pifb kesyon egzamen yo

I PHYSICIAN OR CONIC NAME (PLEASE PRINT) JATELY IMMUNIZED AGAINST 'DANCE. -//,1/2,73 DATE EFTA01710101 FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: FLORIDA STATUTES 232.032, a 10D-3.088, F.A.C. and S. 10M-12, F.A.C. ATE PARENT OR GUARDIAN FIRS I MI DOB moinAnta Child's 5Stt (optional) ST

nan 4yem Nivo reponn pitó kesyon egzamen yo ktnekteman, men li ka gen kek slksè sèlman nan kesyon ki sanble yo gen pi plis difikilte ladan yo. 3 Elèv sa a gen enpe siksè nan matyè ki gen difikilte ladan yo nan egzamen Sunshine State Standards la, men pètómans lan pa rete estab. Yon elèv ki nan 3yèrn