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Gonzales, Texas 78629-9613 Telephone 830-875-2425 SECTION I: ALL QUESTIONS MUST BE ANSWERED PLEASE TYPE OR PRINT CLEARLY If a question does not pertain to your child, please write “NA”. Applicant’s Date of Birth ________________ Applicant’s Social Security Number __________________ ______________________________________________________________________________________ Last Name First Name Middle Name Sex Age ________________________________________________________________________(_____).

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