dc66e42ec4
Categories now match folder names (15 canonical values). Types normalized to 25 canonical values per VAULT_MAP.md spec. Context-aware mapping: W-2s→tax-form, lease files→lease, vet records→vet, etc.
38 lines
1.3 KiB
Markdown
38 lines
1.3 KiB
Markdown
---
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type: vaccine
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category: travel
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person: Yanxin Lu
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date: 2021-12-16
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source: 新冠疫苗接种声明书_lu.jpg
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---
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# 新冠疫苗接种声明书 / Letter of Commitment on COVID-19 Vaccination — Lu Yanxin (Signed Copy)
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This is a scanned/photographed copy of the signed declaration form. The PDF version (疫苗接种声明书_lu.pdf) contains the same content. This JPG shows the completed form with handwritten signature.
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## Declarant Information
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| Field | Value |
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|-------|-------|
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| Name (声明人姓名) | 陆彦忻 |
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| Gender (性别) | 男 (Male) |
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| Date of Birth (出生日期) | 1989年10月17日 |
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| Passport No. (护照号) | E93603635 |
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| Telephone (电话) | +12542241457 |
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| Email (电邮) | crac1017@gmail.com |
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## Vaccination Details
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| Field | Value |
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|-------|-------|
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| Vaccine brand name (疫苗品牌名称) | 辉瑞 (Pfizer) |
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| Vaccination institution (接种机构名称) | Forum Stadium |
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| Address (接种机构地址) | 3900 W Manchester Blvd, Inglewood, CA, 90305 |
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| Contact (接种机构联系方式) | 833-540-0473 |
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| Doses (剂次) | Two doses (二剂次) checked |
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| First dose date (第一剂接种日期) | 2021年4月15日 |
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| Second dose date (第二剂接种日期) | 2021年5月6日 |
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**Signature:** (handwritten signature present)
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**Date:** 2021年12月16日
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