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Efta Id
-
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-
Hash Sha256
fead4ad1d55333d1b9f0e33df7a4c79d7fb548c90c5abe5f7cfb1a337222d5bb
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OCR text
Page 1 LSJE, LLC ok 6I Phi 'NO uarters. Suite 13-3, St. Thomas, VI 00802-1348 E-mail: thesaintjamcs.group(a)gmail.com I mergency Contact Form Today's Date: Stan Date: 01/11/18 Date of Birth: Employee Name: Sylvester Gaillard St Thomas, V1 Physical Address, StThomas, VI Mailing Address: Cell Phone: Phone (other): E-mail: Marital Status: fide/Position: Kupenesor Single Driver's License No: Allergies or Health Concerns: None 0 Unknown Current Medications: riabetic Medications Doctors Name: Dr. Alah Doctor's Phone: Doctor's Name: Doctor's Phone: In case of emergency, please contact: Name: a Name: I Relationship: MOther Relationship: This information is for your safety and the safety Phone: 11 Phone: of others EFTA00003070 ‘ ¥ “ : \ De / , 4 , ‘ . ; ‘s of Wee 4 ’ , Pile . I ‘ - ‘ ¥ 2 7 . ¥ te . 4 - ; y F #4: - LSJE, LLC : y R02 -1 3 6100 Red Hook Quarters, Suite B-3, St. Thomas, VI 00802-1348 ; > Phone a7 E-mail: thesaintjames.group@gmail.com Emergency Contact Form . ee Today's Date lo 1/11/18 Start Date / pee: | Employee Name: |Sylvester Gaillard Date of Birth | — Physical Addres = a J Mailing Addres nhiceaiiag E-mai | Marital Status: [Single Tithe/Position Supervisor Driver's License No: a —— —————————————————————— Allergies or Health Concerns: None Blood type ee isk 3 Current Medications ‘eww Medications ie: z Doctor's Name; |Dr. Alah Doctor's Phone : ae oo Doctor's Name: Doctor's Phone l J In case of emergency, please contact Name Relationship nae Phone | ’ This information is for your safety and the safety of others. a2 - Ree ete BNO TAD a
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EFTA00003070.pdf
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application/pdf
Source path
/srv/provenance-intake/investigations/dcba1340-07e3-447a-a007-c6748522c796/processing/VOL00001/IMAGES/0004/EFTA00003070.pdf
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fead4ad1d55333d1b9f0e33df7a4c79d7fb548c90c5abe5f7cfb1a337222d5bb
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admin
Created
07/15/2026 - 11:53
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Stored OCR text: 1,635 characters
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