TA01683179 FSXMIAP5 CLAIMS MAINFRAME SYSTEM 03/02/2006 ADJUST STATUS UPDATE PROCESSING 09:20 FORM NBR: 1181 RCPT NBR: SRC0325851507 REF NBR: IIRRC A-NBR: AO 79745137 APP TYPE: RECEIVED DATE: 01/04/2005 REMOTE TO: NAME: C/O: STREET: STATE: iiiii INCE: DOB: COB: POLAN SOC SEC NBR: OCCUP