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年度居民名冊調查表
(English characters only please)
您的姓名
名字*
中間名
姓氏*
字尾
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Jr.
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II
III
IV
性別*
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男
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目前居住地址*
(不可以用郵政信箱號碼或商號的地址)
街道號碼與名稱*
公寓號碼或樓層
地區*
請選一項
Allston
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郵遞區號*
目前郵寄地址
(如果和上面地址不同)
街道號碼與名稱
公寓號碼或樓層
城市
州
AA
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AP
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DE
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郵遞區號
去年居住地址
(如果和上面地址不同)
您的出生日期
月*
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日*
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年*
----
1900
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1911
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職業*
電話號碼*
(僅限數字)
養狗數目
(如果有養)
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