Transcription of EASY CARD SERVICES - Miami-Dade County
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EASY CARD SERVICES - Miami-Dade County
The personal information requested in this document is for statistical and record keeping purposes only. La informaci n personal que se solicita en este documento tiene fines estad sticos y de archivo solamente. Tout enf masyon ke nou mande nan dokiman sa-a se pou estatistik pa nou epi pou travay biwo pa nou-an s lman. Social Security Number:Date of Birth:Fecha de Nacimiento / Dat Ou F t N mero de Seguro Social / Nimewo Sosval Name:Sexo / Ki sa w ye Nombre / Non Gender: MaleMasculino / Gason FemaleFemenino / Fi Mailing Address:Direcci n Postal / Adr s Postal City:Ciudad / Vil State:Estado / Eta Zip Code:C digo Postal / Zip K d Phone Number:Tel fono / Nimewo Telef nRace/Ethnicity (Check only one) Raza/Etnia (Escoja solo una) Ki ras ou (Mete sa w vle ye-a)American Indian / Alaskan NativeNativo Americano Nativo de Alaska Ameriken Endyen, ou moun AlaskaAsian / Pacific IslanderAsi tico de las islas del Pac fico Azyatik oubyen z n pasifik HispanicHispano Pany lAfrican-AmericanNegro, no de origen hispano Nwa, ki pa pany lWhite, not HispanicBlanco, no de origen hispano Blan, ki pa pany lUnder penalty of perjury, I declare that I have read the Golden passport application and that the facts stated in it are true.
EASY CARD SERVICES GOLDEN PASSPORT EASY CARD APPLICATION Your Golden Passport EASY Card is non-transferrable. If someone else is found using your card, it will be confiscated and you will not be able to participate in the program for one year. Golden Passport holders are not eligible for any other discounted or free fare. Replacement fee for lost
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