4. If you answered "Yes" to Item Number 13.24 provide thetfoimatiortrequeSteditiban Number13.1). Form 1-765 12126/19 Page 2 of 7 EFTA01699768 'Pant kfOrMatiott About VOu (tentanUed)/ List the city/town/village, state/province, and country where you were born. 27. Eligibility Category. Reflect° the Who 1