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)

ing the school day? .0 YES 0 NO If YES, provide the school with a copy of the court order. PESO 0636 (REV. 5/29/2001) page 1 of 2 EFTA01709611 THE SCHOOL DISTRICT OF PALM BEACH COUNTY - NEW AND RETURNING STUDENT REGISTRATION (36) FATHER OR LEGAL GUARDAN first rmcWe Hap SAD IIIIIII IIIII PU: Y giimOR4211 OR LEGAL GUARDIAN (last mAMM

14 Form 3040 which easy be used) Mock Plumbot. 5744400.3040-2) Authorized Signature-- Date EFTA01709711 FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: sections 232.032, 402.305, 402.313, Florida Statutes; rules 64D-3.011, 65C-22.006, 65C-20.011, Florida Administrative Code LAST NAME PARENT OR GU

the school day? O YES .NO If YES, provide the school with a copy of the court order. - ' PBSD 0636 (REV. 4/6/2001) page 1 of 2 EFTA01709714 THE SCHOOL DISTRICT OF PALM BEACH COUNTY - NEW AND RETURNING STUDENT REGISTRATION (36) FATHER OR LEGAL GUARDIAN 031st mkIdle Alia( Ms° (37 ADDRESS (SOW nomboS 7-4" 94 4:1311Tvnlixdpber) IIIIIII

TY MIAMI FL 33188.0001 NEW Charges Past Due Total Now Due AUG 21 2003 $228.20 EFTA01710059 • • I' FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: sections 232.032, 402.305, 402.313, Florida Statutes; rules 640-3.011.65C-22.006, 65C-20.01I, Florida Administrative Code LAST NAME PARENT OR GUA

dent during the school day? U YES Wil0 provide the sotto& with a copy of the court order. PBSD 0636 (REV. 02/04/2002) page t o12 EFTA01710055 THE SCHOOL DISTRICT OF PALM BEACH COUNTY - NEW AND RETURNING STUDENT REGISTRATION v - ! -. an k C A- t STATE ZIP COCE pa d 6. FL d3V I1 On l0Jtii Palm STATE ZIP CODE PL 334 1 ' 0OCU

FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: sections 232.03Z, 402.305, 402.313, Florida Statutes; rules 640-3.011, 65C-22.006, 65C-20.011, Florida Administrative Code LAST N FIRST NAME MI

ng the school day? O YES NO If YES, provide the school with a copy of the court order. • PBSD 0636 (Rev. 03/19/2003) page 1 of 2 EFTA01710230 THE SCHOOL DISTRICT OF PALM BEACH COUNTY - NEW AND RETURNING STUDENT REGIS 1 ) FATHER CR LEGAL GUARDIAN (Sat 77404 int.9. 7779 (34) DATE OF BIRTH (45) DATE OF BIRTH 5 - • Oa - (.0 7 DO ADD

TY MIAMI FL 33188.0001 NEW Charges Past Due Total Now Due AUG 21 2003 $228.20 EFTA01727112 • • I' FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: sections 232.032, 402.305, 402.313, Florida Statutes; rules 640-3.011.65C-22.006, 65C-20.01I, Florida Administrative Code LAST NAME PARENT OR GUA

dent during the school day? U YES Wil0 provide the sotto& with a copy of the court order. PBSD 0636 (REV. 02/04/2002) page t o12 EFTA01727108 THE SCHOOL DISTRICT OF PALM BEACH COUNTY - NEW AND RETURNING STUDENT REGISTRATION I I- an - kOODUP eVitt Palm STATE ZIP COCE bud', FL 83Y 1 L CITY ..„ al m iatieeh a STATE ZIP COD