[All]
Date of birth
5. Month and year of birth and age last birthday
Print
Month
_____
Year
_____
Age
_____
"If the month or year of birth, or the age, is not known, give your best estimate."
6. Month of birth
Fill one circle
[] Jan. - Mar.
[] Apr. - June
[] July - Sept.
[] Oct. - Dec.
7. Year of birth
Fill one circle for first three numbers
[] 186-
[] 187-
[] 188-
[] 189-
[] 190-
[] 191-
[] 192-
[] 193-
[] 194-
[] 195-
[] 196-
[] 197-
Fill one circle for last number
[] 0
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9