File In No. tJ ~- 6 Obb

Federal Property:
Impact Aid Program Source Check Form Extract
The survey date is December 11, 2007.
CA003073 Address: 610 E 18TH 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
Christi Johnson/Anlwan Adger 610 E 18th St #J
Kenya Williams 7636 Ney Ave #4
YES I NO YES I NO
X Antwanette Adger 10/5/2001 1
X Rakya Banks 6/21/2002 0
Helen Thomas 2468 Coolidge Ave #B X Diamond Baylor 217/1991 12
LANITA WYATT 610 E 18TH ST #F
ltika Robinson 1422 47th Ave #7
MELODY FRYE/RICHARD ORA 7636 NEY AVE #3
X Lanisha Branch 11/24/1994 8
X Panaisla Brewer 1/25/2002 0
X XAVIER DRAPER 4/29/2001 1
KIM YOEUN EAP 3302 BROOKDALE AVE #2 X DonjaJica Eap 1213011992 9
Donna Tompson 2468 Coolidge Ave #0
KENYA WILLIAMS 7636 Ney Ave #4
ANGELA LEE 755 ALCATRAZ AVE #H
LAJOYA JUNIEL 755 ALCATRAZ AVE #1
Ruan, Bing Bing/Hu. Wei Xiong 2925 E 16th St #3
X Se'Quan Edmonds 6/2211995 7
X Malik Grant Jr 11/29/1995 6
X Jamie Harmon 2124/1991 10
X QuenneJl Harris 1211/1990 12
X Yong Hu 5/11/2002 0
FLETCHER. JACKI E 610 E 18th St#E X Hassan Hunter 4/1/1997 5
JACKIE FLETCHER 610 E 18th St#E
This is to certify that the Infonnation shown under columns (4) and (5)
of the foregoing sheet(s) Is correct for the person listed under Column (1)
on the survey date.
Signature
X Malaysia Hunter 3/2511999 3
This Is to certify that the Infonnatlon shown under columns (4) and (5)
of the foregoing sheet(s) Is correct for the person listed under Column (1)
on the survey date.
Date Signature Date
Tille Agency Tille School District
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.