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Impact Aid Program Source Check Form Extract<br />
The survey date is December 11, 2007.<br />
FederalProperty: CA003056 Address: 9024 CHERRY ST<br />
(1) (2) (3) (4) (5) (6) (7) (8)<br />
Parent/Guardian's Parent/Guardian's Branch of Service Parent/Guardian Parent/Guardian Name of Pupil Living With Pupil's Pupil's<br />
Name Address (<strong>In</strong>cluding rank, <strong>In</strong> Column (1) in Column (1) Parent/Guardian in Date of Grade<br />
if applicable) lived on worked on Column (1) Birth<br />
or above property above property<br />
Foreign Military as of as of<br />
Government survey date survey date<br />
YES I NO YES I NO<br />
VALARIE BELCHER 9024 Cherry St #3 X Jaleesa Belcher 8/9/1990 12<br />
ROBIN ANDERSON 2102 E 17TH ST #A X Kenneisha Caston 6/2211990 12<br />
Antoinette Holland 972 61st St #3 X Akilah Chase 1212211993 8<br />
FEN LI HE/David Choi 1951 E 24th St #1 X Michael Choi 9/25/1993 8<br />
Li Feg He 1951 E 24th St #1 X Steven Choi 10/23/2000 2<br />
David/Lily Choi 1951 E 24th St #1 X Stewart Chol 10/23/2000 2<br />
RHONDA CLARKI john murphy 9220 sunnyside st #6 X Jose Clark 6/15/1993 8<br />
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