ress From: (State) (Zip) To: 2. (Swot Address or baton) County: (C ty) Dates you will be at this address: From: (Stale) (Zip) To: 3. (Sueel Address or locnon) County (Cly) Dates you will be al this address. From: (Stets) (Zip) To: Employment • I am currently unemployed. 1. Employer: Fta