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1. Basic information
Date of Birth*
Month
January
February
March
April
May
June
July
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September
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November
December
Day
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Year
2019
2018
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1923
1922
1921
1920
Country*
United States of America
Canada
France
Germany
Italy
Netherlands
Singapore
Switzerland
United Kingdom of Great Britain and Northern Ireland
State*
Alaska
Alabama
Arkansas
Arizona
California
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Connecticut
District of Columbia
Delaware
Florida
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Hawaii
Iowa
Idaho
Illinois
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Texas
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Wyoming
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