Concurrent claims are filed on account #123-00-6789 by the disabled NH, Mary Ann Pharr
(maiden name Neer) and child Wayne Pharr; Wayne's DOB is 4 /11/96. The child's birth
certificate is presented as proof of age, citizenship and relationship for the child
and as proof of age for the NH. Two Evidence Screens must be completed.
NHs Screen
CLIENT: Mary Ann Pharr
CROSS REFERENCE SSN: 999999999 999999999 999999999
SELECT PROGRAM: 1 1. Title II 2. Title 16 3. Title 18
SELECT TYPE: 2 1. Preclaim 2. Claim 3. Postentitlement
DOCUMENT SUBMITTED AS PROOF OF THE FOLLOWING EVENTS/ISSUES:
X AGE - LAWFUL ALIEN STATUS - RELATIONSHIP -IDENTITY
- CITIZENSHIP - LIVING ARRANGEMENT - RESOURCES - WAGES
- DEATH - MARRIAGE - SELF EMPLOYMENT - OTHER
- DIVORCE - MILITARY SERVICE - UNEARNED INCOME
DOCUMENT EVENT DATE: 04111996 ISSUANCE/RECORDATION DATE (Y/N): Y
IF YES, DATE RECORDED: 04111996DATE ISSUED: 04301996
DOCUMENT TYPE: CBC-Wayne Pharr LANGUAGE: SSSSSSSS
PLACE DOCUMENT CREATED: CITY: SEATTLE STATE:WA COUNTRY: XX OTHER: XXXXXXXXXXXXXXXXX
RECORD ID(RIN)(Y/N): Y IF YES, RIN:66432109-86
COMMENTS: N/Hs age at C's birth is 24 yrs.
MTH Name - Mary Ann Neer
NM: P PPPPPPPPPP POSITION: PPPP OFFICE CODE: PPPP DATE: PPPPPP
ADDITIONAL EVIDENCE (Y/N): X PAGE: S
CHILD'S Screen
CLIENT: Wayne Pharr
CROSS REFERENCE SSN: 123006789 999999999 999999999
SELECT PROGRAM: 1 1. Title II 2. Title 16 3. Title 18
SELECT TYPE: 2 1. Preclaim 2. Claim 3. Postentitlement
DOCUMENT SUBMITTED AS PROOF OF THE FOLLOWING EVENTS/ISSUES:
X AGE - LAWFUL ALIEN STATUS X RELATIONSHIP - IDENTITY
X CITIZENSHIP - LIVING ARRANGEMENT - RESOURCES -WAGES
- DEATH - MARRIAGE - SELF-EMPLOYMENT - OTHER
- DIVORCE - MILITARY SERVICE - UNEARNED INCOME
DOCUMENT EVENT DATE: 06151997ISSUANCE/RECORDATION DATE (Y/N): y
IF YES, DATE RECORDED: 04111996 DATE ISSUED:04301996
DOCUMENT TYPE: BC XXXXXXXXXXXXXXXXXXXXXXXXXXX LANGUAGE: SSSSSSSS
PLACE DOCUMENT CREATED: CITY: SEATTLE STATE:WA
COUNTRY: XX OTHER: XXXXXXXXXXXXXXXXX
RECORD ID(RIN)(Y/N): Y IF YES, RIN: 66432109-86
COMMENTS: MTH: Mary Ann Pharr
NM: P PPPPPPPPPP POSITION: PPPP OFFICE CODE: PPPP DATE: PPPPPP
ADDITIONAL EVIDENCE (Y/N): X PAGE: S