Questionnaire Text

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Dwelling's address

____ District
____ City (town), urban district, urban settlement (posiolok)
____ Rural settlement, rural administrative district
____ Name of the street, avenue (prospect), square, lane (alley), passage (thoroughfare)
____No. of the house (No. of building, if there are several) or full name of the house owner
____ Apartment (flat) number
____ Name of the institution, organization