FF-12 – Medical record release

FF-12-A-1

Jonestown, Port Kaituma
Northwest District
Cooperative Republic of Guyana

I, Danny K. Kutulas, being duly sworn, declare that I release all medical records and documents pertaining to me to Dr. Carlton Goodlett.

Subscribed to and sworn to me,
a commissioner of oaths for the
Republic of Guyana.

Dated August 5, 1977
Witnessed:

—–

FF-12-A-2

Jonestown, Port Kaituma
Northwest District
Cooperative Republic of Guyana

I, Dave B. Jackson, being duly sworn, declare:

I, Dave B. Jackson, release all medical records and documents pertaining to me to Dr. Goodlett.

Subscribed to and sworn to me,
a commissioner of oaths for the
Republic of Guyana.

Dated August 5, 1977
Witnessed:

—–

FF-12-A-3

Jonestown, Port Kaituma
Northwest District
Cooperative Republic of Guyana

I, Mary Louise Shavers, being duly sworn, declare:

I, Mary Louise Shavers, request that all my medical records be released to Dr. Carlton Goodlett.

Subscribed to and sworn to me,
a commissioner of oaths for the
Republic of Guyana.

Dated August 5, 1977
Witnessed:

—–

FF-12-A-4

Jonestown, Port Kaituma
Northwest District
Cooperative Republic of Guyana

I, Jack D. Barron, being duly sworn, declare:

I, Jack D. Barron, hereby release all medical records and documents pertaining to me to Dr. Carlton Goodlett.

Subscribed to and sworn to me,
a commissioner of oaths for the
Republic of Guyana.

Dated August 5, 1977
Witnessed:

—–

FF-12-A-5

Jonestown, Port Kaituma
Northwest District
Cooperative Republic of Guyana

I, Earnestine T. March, being duly sworn, declare:

I, Earnestine T. March, would like my medical reports and records released to Dr. Carlton Goodlett.

Subscribed to and sworn to me,
a commissioner of oaths for the
Republic of Guyana.

Dated August 5, 1977
Witnessed:

—–

FF-12-A-7

Jonestown, Port Kaituma
Northwest District
Cooperative Republic of Guyana

I, Liane Harris, being duly sworn, declare:

I, Lianne Harris, hereby release all medical records and documents pertaining to me to Dr. Carlton Goodlett.

Subscribed to and sworn to me,
a commissioner of oaths for the
Republic of Guyana.

Dated August 5, 1977
Witnessed:

—–

FF-12-A-19

Jonestown, Port Kaituma
Northwest District
Cooperative Republic of Guyana

I, Jeffrey J. Carey, being duly sworn, declare:

I hereby release all medical records and documents pertaining to me to Dr. Carlton Goodlett.

Subscribed to and sworn to me,
a commissioner of oaths for the
Republic of Guyana.

Dated August 5, 1977
Witnessed: