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."

[] United States
or
_____
(Name of foreign country; or Puerto Rico, Guam, etc.)