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Efta Id
-
Dataset
-
Hash Sha256
176556df1e0f20cc5acc184c74665a424b869500a4d9a2d60d2fd64d77bc8b9e
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OCR text
Page 1 LSJE, LLC 6100 • 1 sok Phone: uarters, Suite B-3, St. Thomas. VI 00802-1348 E-mail: thesaintjames.group@gmail.com Emergency Contact Form 110/17/18 Today's Date: Start Date: Employee Name: Brian Bates Date of Birth: Physic3! Address: Mailing Address: Cell Plior Phone (other): E-mail. Marital Status: Title/Position: IGOntrader Allergies or Health Concerns: Single Driver's License No: IM Blood type: El A- O A+ lE AB- El AB+ El 8- lit O O. El O+ Unknown Current Medications: h ne Doctors Name: Jamie Reed Doctors Phone: Doctor's Name: None Doctor's Phone: In case of emergency, please contact: Name: Relationship: Girlfriend Name: Relationship: This information is for your safety and Phone: Phone: the safety of others. EFTA00003044 ‘ , LSJE, LLC 6100 Red Hook Quarters, Suite B-3, St. Thomas, VI 00802-1348 a Phone E-mail: thesaintjames.group@gmail.com . ) Emergency Contact Form 4 Title/Positior |Contractor Driver's License No: mae Allergies or Health Concerns | | ; Blood type A A+ CD AB ( AB+ oe ) B+ Oj o- C O+ ] Unknown Current Medications: _ ; . Doctor's Name: amie Reed Doctor's Phone: = f& in case of emergency, please contact Name fF _i Relationship: (Gintrieng Phone: Cee : 5 This information is for your safety and the safety of others. EFTA00003044
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EFTA00003044.pdf
Content type
application/pdf
Source path
/srv/provenance-intake/investigations/dcba1340-07e3-447a-a007-c6748522c796/processing/VOL00001/IMAGES/0004/EFTA00003044.pdf
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176556df1e0f20cc5acc184c74665a424b869500a4d9a2d60d2fd64d77bc8b9e
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admin
Created
07/15/2026 - 11:46
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Document status: uploaded
Stored OCR text: 1,330 characters
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