HomeMy WebLinkAboutSchool District 8 Purdy Enfield (185) (See Back of Sheet for Full Explanation)
I Crippled 3 Hearing 5 Heart 7 Mental
2 Sight 4 Speech 6 Others
IS CHiI.D ATIENDINO SCHOOL? IF Nor
NUMBER TO SHOW KIND DATE OF BIRTB POST OFFICE OR RURAL NAME OF ATTENDING. STATE SERVICE Nl®SS.
NAME (LAST,FIRST, MIDDLE) OF HANDICAP. I.E.,TRANSPORTATION,HOPE TEACHES,
S68 ABOVE- M0. DAY yR ROUTE N0.ADDRESS PARENT OF GUARDIAN ARTIFICIAL APPLIANCE ETC,
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Signature of teacher---,,%JJ� /�G--/11. ..........Address......v`...!t�LLC Lz...�...5� .......l.r.. ......... ��.
School district no. .J.4..... Town of--.---.-- - _ .................. County of........ ... . ......Supervisory district no.v"l..................
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