EFTA00004250-p-90.jpg

The image shows an orange paper with printed and handwritten text on it. The printed text at the top reads "ITEM WAS NOT SCANNED" in bold letters, indicating that whatever item this form is related to has not been scanned through a system, possibly for inventory or security purposes. Below this, there's a line where additional information can be written; however, only the initials "CJ" are visible on the handwritten part of the text. At the bottom of the paper, there is more printed text which includes the words "OFFICIAL DOCUMENT INSTRUCTIONS" and "RECEIVED MAY 17, 2009," suggesting that this form was received as an official document on May 17th in a year that appears to be 2009. The overall condition of the paper suggests it's been handled or used previously, with visible wear and creases.