First Name:

Last Name:

Other Name:

Gender:

Marital status:

City:

Year of birth:

Satoru

Nishida

Joe

M

Single

San Luis Obispo

1904

Entry Type:

DE

Entry Date:

​

Departure Type:

Term W/G

Departure Date:

​

Destination City:

Ogden

Destination State:

UT

Family #:

31337

Individual #:

31337A

Citizenship:

A

Camp Address:

1-14-13-D

Farline Id:

11001