If the only known address is a post office box, give a description of the work location. For example, print the name of the building or shopping center where the person works, the nearest intersection, or the nearest street where the workplace is located, etc. DO NOT GIVE A POST OFFICE BOX NUMBER.

If the person worked at a military installation or military base that has no street address, report the name of the military installation or base, and a description of the work location (such as building number, building name, nearest street or intersection).

If the person worked at several locations, but reported to the same location each day to begin work, print the street address of the location where he or she reported. If the person did not report to the same location each day to begin work, print the address of the location where he or she worked most of the time last week.

If the person's employer operates in more than one location (such as a grocery store chain or public school system), print the street address of the location or branch where the person worked. If the street address of a school is not known, print the name of the school, and a description of the location (such as nearest street or intersection).

If the person worked on a college or university campus and the street address of the workplace is not known, print the name of the building where he or she worked, and a description of the location (such as nearest street or intersection).

If the person worked in a foreign country or Puerto Rico, Guam, etc., print the name of the country on the state or foreign country line.

If the only known address is a post office box, give a description of the work location. For example, print the name of the building or shopping center where the person works, the nearest intersection, or the nearest street where the workplace is located, etc. DO NOT GIVE A POST OFFICE BOX NUMBER.

If the person worked at a military installation or military base that has no street address, report the name of the military installation or base, and a description of the work location (such as building number, building name, nearest street or intersection).

If the person worked at several locations, but reported to the same location each day to begin work, print the street address of the location where he or she reported. If the person did not report to the same location each day to begin work, print the address of the location where he or she worked most of the time last week.

If the person's employer operates in more than one location (such as a grocery store chain or public school system), print the street address of the location or branch where the person worked. If the street address of a school is not known, print the name of the school, and a description of the location (such as nearest street or intersection).

If the person worked on a college or university campus and the street address of the workplace is not known, print the name of the building where he or she worked, and a description of the location (such as nearest street or intersection).

If the person worked in a foreign country or Puerto Rico, Guam, etc., print the name of the country on the state or foreign country line.

If the only known address is a post office box, give a description of the work location. For example, print the name of the building or shopping center where the person works, the nearest intersection, or the nearest street where the workplace is located, etc. DO NOT GIVE A POST OFFICE BOX NUMBER.

If the person worked at a military installation or military base that has no street address, report the name of the military installation or base, and a description of the work location (such as building number, building name, nearest street or intersection).

If the person worked at several locations, but reported to the same location each day to begin work, print the street address of the location where he or she reported. If the person did not report to the same location each day to begin work, print the address of the location where he or she worked most of the time last week.

If the person's employer operates in more than one location (such as a grocery store chain or public school system), print the street address of the location or branch where the person worked. If the street address of a school is not known, print the name of the school, and a description of the location (such as nearest street or intersection).

If the person worked on a college or university campus and the street address of the workplace is not known, print the name of the building where he or she worked, and a description of the location (such as nearest street or intersection).

If the person worked in a foreign country or Puerto Rico, Guam, etc., print the name of the country on the state or foreign country line.

If this person worked at more than one location, print where he or she worked most last week.

a. Address (Number and street)

____________________________________________________________
(If the exact address is not known, give a description of the location such as the building name or the nearest street or intersection.)

___________________________________________________________

c. Is the work location inside the limits of that city or town?

[] Yes
[] No, outside the city/town limits

d. County____________________

e. State____________________

f. ZIP Code__________________

If this person worked at more than one location, print where he or she worked most last week. If one location cannot be specified, see instruction guide.

"If the person worked at several locations, but reported to the same location each day to begin work, print where he or she reported. If the person did not report to the same location each day to begin work, print the words "various locations" for 23a, and give as much information as possible in the remainder of 23 to identify the area in which he or she worked mostlast week. If the person's employer operates in more than one location (such as a grocery store chain or public school system), give the exact address of the location or branch where the person worked. If the person worked in a foreign country or Puerto Rico, Guam, etc., print the name of the country in 23e and leave the other parts of 23 blank."

a. Address (Number and street)

________________________________________

If street address is not known, enter the building name, shopping center, or other physical location description.

b. Name of city, town, village, borough, etc.

____________________________________________________________________________

c. Is this place of work inside the incorporated (legal) limits of that city, town, village, borough, etc.?

____________________________________________________________________________

e. State __________

f. ZIP Code _______________________