Questionnaire Text

Questionnaire form view entire document:  text  image
7. Where was this person born?
[ ] In the United States - Print name of state._______________________
[ ] Outside the United States - Print name of foreign country, or Puerto Rico, Guam, etc.__________________________
Questionnaire instructions view entire document:  text  image
7. For people born in the United States:

Mark the "In the United States" box and then print the name of the state in which the person was born. If the person was born in Washington, D.C., print "District of Columbia."