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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

es not meet Minimum Creditable Coverage standards and will not satisfy the individual mandate that you have health insurance. As of January 1 2009. the Massachusetts Health Care Reform Law requires that Massachusetts residents, eighteen (18) years of age and older, must have health coverage that meets the Minimum Creditable Coverage st

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

es not meet Minimum Creditable Coverage standards and will not satisfy the individual mandate that you have health insurance. As of January 1 2009, the Massachusetts Health Care Reform Law requires that Massachusetts residents, eighteen (18) years of age and older, must have health coverage that meets the Minimum Creditable Coverage st

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

oes not meet Minimum Creditable Coverage standards and will not satisfy the individual mandate that you have health insurance. As of January I 2009. the Massachusetts Health Care Reform Law requires that Massachusetts residents, eighteen (IS) years of age and older, must have health coverage that meets the Minimum Creditable Coverage st