PRIVACY ACT MATERIAL REMOVED
Name
ee
—
S
~~...
,
<
¢
CG
Ci
J
Sex
F
TOF
ht
Q
Majuro, Maxs "ee
Special He
tb
GOVERNMENT OF THE MARSHALL ISLANDS
Mf
Agé
we
Residence: L IKIEP
1954-1960
1950-1966
1966-1972
L1972-
Sr.oxt description of symptoms:
Inrestulel, Casicer - Tanto
Surgery
YES
Se
Year) —
S974
nave vou been receiving treatment for any illness for uw perice
over one year?
Abo.
sGs anyone in your family complained of similar symptoms to toc
OLES you are now experiencing?
YES
Aonature
-
_
01184
Date | S109
PRIVACY ACTMATERIAL REMOVED