r 1-1, yen, mondts; that I now reside at L-1 ++(C • :SCATilec; ss knii-s within shetnrsie bleeds; that I was born JC:011 ; 3)0, 1053 at Kieuo (Pafratnni)k lc Pt (Place of birth) (If naturalized, give place and date of naturalization) ; that (I am a legal voter) (I am qualifying-as-a