PRIVACY ACT MATERIAL REMOVED GOVERNMENT OF Ti MARSHALL ZSLANDS Majuro Marsnass tslandas So0eci nealts1 SOL VLY ex /7 we age 27 1954-1960 —- Gd 1960-1965 be 1966-1972 _ 197 2- 4 tt havc you been receiving treatment for overs one year? ( any illness for a pericssc ry, has anyone in your family complained of similar symptoms to the Oncs you are now experiencing? (ye Surgery? Signature ( Duh con [Ciexfetee) ? bg _ J011 38Gb ate fz 1 PRIVACY ACT MATERIAL REMOVED