VA Form 0711 (Portland VA Medical Center)

Part B - Photographic identification number 1 - Completed by Registrar. Item 1 - Enter the full exact name as seen on the Applicant's ID. Item 2 - Enter IDs number, (i.e. license number, passport number) Item 3 - Enter date that ID number 1 expires. Item 4 - Enter the type of ID presented, (i.e. Virginia state issued drivers license) ................
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