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GROUP & PENSION ADMINISTRATORS, INC. P.O Box 748075 ‘STATEMENT OF CLAIM Dallas, Texas 75574-0075 MEDICAL "ART A — Employoo information = Fane rae ation Internation and Aurion to Release Information = Oe sa ranean aT eS om _1 vena ar 8 : Eros an oe ssn rors omenden Sr ise rc poet oi one nego va nese? Owes Ch Tena wm rowed? Eve Ce [sects ancsaacas Gye oie ‘Sar ate Foe aba la eal abi ieaee? Clver Ele 1 ig ay. ay out sea a lease GoeraralpaT CIYes CONE FRESE amas [am nn nm npr lw Cia i ee ‘Satewscyouartepororcameengaos? Cee Che nT onerem wows Tee eres 7 epee Se Se SS Dive Oe owe ae vc at Nae C ra I a aT GE ——| FRA ay TN Fa ERT RSS TST ‘WSS iss "tiem Spay = rapa smear nama oma se ones, sd roe? gy ou tocar tama deo fy tase bo Peon ‘oo oy a at na Sts tay ane brea e's ane cae cng ay ke, meant om es ar ROTTS PART © — Enployar nforaton ae Pa Pa SA

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