Last Update: 9/13/05 (Transmittal I-4-15)
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In the case of _______________________________ (Claimant) |
Claim for _______________________________ (Social Security Number) |
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_______________________________ (Wage Earner) |
_______________________________ (Social Security Number) |
LIST OF ADDITIONAL EVIDENCE
Medical report from Robert T. Jones, M.D. dated July 5, 1988.
Professional qualifications of Robert T. Jones, M.D.