c. Year of birth
Print year in the spaces, and fill one circle below each number.

___ ___ ___ ___

1[] 8[] 0[] 0 []
9[] 1[] 1 []
2[] 2 []
3[] 3 []
4[] 4 []
5[] 5 []
6[] 6 []
7[] 7 []
8[] 8 []
9[] 9 []

"Enter age at last birthday in the space provided (enter "0" for babies less than one year old). Also enter month and year of birth, andfill the appropriate circles. For an illustration of how to complete question 5, see the example on pages 4 and 5 [not shown here]. If age or month or year of birth is not known, give your best estimate."