File In No. tJ ~- 6 Obb

Annette Boyd
ANNETTE BOYD
Impact Aid Program Source Check Form Extract
The survey date is December 11, 2007.
FederalProperty: CA003027 Address: 9510 SUNNYSIDE ST
(1) (2) (3) (4) (5) (6) (7) (8)
Parent/Guardian's Parent/Guardian's Branch of Service Parent/Guardian Parent/Guardian Name of Pupil Living With Pupil's Pupil's
Name Address (Including rank, In Column (1) In Column (1) Parent/Guardian In Date of Grade
If applicable) lived on worked on Column (1) Birth
or above property above property
Foreign Military as of as of
Government survey date survey date
7908 Ney Ave #4
7908 NEY AVE #4
Number Students At This Property 44
This Is to certify that the Information shown under columns (4) and (5)
of the foregoing sheet(s) Is correct for the person listed under Column (1)
on the survey date.
YES I NO YES I NO
x
X
Kiaira Wright
Tiaira Wright
This is to certify that the Information shown under columns (4) and (5)
ofthe foregoing sheet(s) Is correct for the person listed under Column (1)
on the survey date.
Signature Date Signature Date
TItle Agency Tille School District
10/6/1998
3123/1994
This Information Is the basis for payment to this school district of federal funds under the Impact Aid Program (Title Viii of the Elementary and Secondary Education Act).
This form must be signed and dated for this school district to receive funds based on this Information.
4
8