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Applicant | Gender | Age | DOB | Tobacco Use |
Sample | Male | 54 | 1/1/1967 | No |
Jackie | Female | 20 | 1/1/2001 | No |
Joe | Male | 41 | 1/1/1980 | No |
Proposal ID: 45801908-7509800988027913 | Proposed Effective Date: 1/1/2021 | Email: Steveshorr@cox.net |
Zip: 90731 | County: Los Angeles | State: CA |
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