Questionnaire Text

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13a. Where was this person born? If born in hospital, give State or country where mother lived. If born outside U.S., see instruction sheet; distinguish Northern Ireland from Ireland (Eire).
[] This State
OR _____________________________________________________
(Name of State or foreign country; or Puerto Rico, Guam, etc.)

"Mark the circle for This State if he now lives in the same State as he was born in. If born in a different State, print name of State. If born outside U.S., print name of country, U.S. possession, etc. Use international boundaries as now recognized by the U.S."