[ALASKA STATE MEDICAL BOARD (CHECKLIST - RESIDENT PERMIT [appuicanr mronmanion | revees [aneioe] © oyfis__) Ste SE) Soon = Geeta von BE] ‘Fees: Application & Permit Fee ($100.00) wows no [2521486] we ra [Sn y0108_Asplcaton, w/ Phtootay OEE Ath. fr Relate of Racode asd tos See De —_ 10808 vacanr to Me Ste 03/04/08. Residency Program Verification pocedine 40108 Acanc f Pegoity fom Ata Fy ove an oe ay Pearce —Jouroue. aaa a cera veteson ef enero Pn Sool] eo TE sem] rn Fe me Sort fea semester One tam Gar Pre a ‘Son ‘nme som — re ao oar 7 SEA x 1 rots ar Aten an Bn apt —— ps tamieemoe- omnes ca —— urea Ap Compr inate eens aie Poem emerctaiccirent [et betty LET halos nar orm sesienipertns, [—] afone _Vefteatow tener ea Oper Hom Cx Proce en petine 0108 Fea Boat Acton Oat Bank Rept 7 — a somone fox) Te Metal Cae ) a ‘Saf a onl ince Sal Saul eo RECEIVE JUNEAU 7 APR AT 2508 cansing amines [Banwtodnoace STATE OF ALASKA tecte: 0901/2008 pies: 0990/2008 DEPARTMENT OF COMMERCE, COMMUNITY, AND ECONOMIC. Division of Occupational Licensing STATE MEDICAL BOARD Certifies that DIVYA KELATH SHAH IS A PHYSICIAN IN A RESIDENCY PROGRAM [RESIDENT PERMIT FOR ANC ANCHORAGE ‘Commissioner: Emil Notts Roa ‘State OF Alaska Depa Com anmiy oEap Done oof crt ‘Seva aca ea 6018 IW HOSLY NNY AVM AV IOUVE 682 HVHS HIV VAAIG