[104-10225-10007.pdf — page 227]
# PAGE 8SECTION 19. RESIDENCES FOR PAST 15 YEARS (CONTINUED FROM PAGE 7)| FROM: | TO: | ADDRESS STREET AND NUMBER | CITY | STATE | COUNTRY || ----- | --- | ------------------------- | ---- | ----- | ------- ||       |     |                           |      |       |         || FROM: | TO: | ADDRESS STREET AND NUMBER | CITY | STATE | COUNTRY ||       |     |                           |      |       |         || FROM: | TO: | ADDRESS STREET AND NUMBER | CITY | STATE | COUNTRY ||       |     |                           |      |       |         || FROM: | TO: | ADDRESS STREET AND NUMBER | CITY | STATE | COUNTRY ||       |     |                           |      |       |         || FROM: | TO: | ADDRESS STREET AND NUMBER | CITY | STATE | COUNTRY ||       |     |                           |      |       |         |SECTION 20. RESIDENCES OR TRAVEL OUTSIDE THE UNITED STATES| FROM: (MO. AND YR.) | TO: (MO. AND YR.) | CITY OR SECTION | COUNTRY | PURPOSE || ------------------- | ----------------- | --------------- | ------- | ------- ||                     |                   |                 |         |         || FROM: (MO. AND YR.) | TO: (MO. AND YR.) | CITY OR SECTION | COUNTRY | PURPOSE ||                     |                   |                 |         |         || FROM: (MO. AND YR.) | TO: (MO. AND YR.) | CITY OR SECTION | COUNTRY | PURPOSE ||                     |                   |                 |         |         || FROM: (MO. AND YR.) | TO: (MO. AND YR.) | CITY OR SECTION | COUNTRY | PURPOSE ||                     |                   |                 |         |         || FROM: (MO. AND YR.) | TO: (MO. AND YR.) | CITY OR SECTION | COUNTRY | PURPOSE ||                     |                   |                 |         |         || FROM: (MO. AND YR.) | TO: (MO. AND YR.) | CITY OR SECTION | COUNTRY | PURPOSE ||                     |                   |                 |         |         |SECTION 21. CLUBS, SOCIETIES AND OTHER ORGANIZATIONS.NOTE: IN SPACE BELOW LIST NAMES AND ADDRESSES OF ALL DOMESTIC AND FOREIGN CLUBS, SOCIETIES AND ORGANIZATIONS OF ALL KINDS TO WHICH YOU HAVE BELONGED, OTHER THAN RELIGIOUS SOCIETIES, POLITICAL PARTIES AND LABOR UNIONS. INCLUDE ANY ORGANIZATION HAVING HEADQUARTERS OR A BRANCH IN A FOREIGN COUNTRY OF WHICH YOU HAVE BEEN A MEMBER OF TO WHICH YOU HAVE GIVEN SUPPORT.| NAME | STREET AND NUMBER | CITY | STATE | COUNTRY || ---- | ----------------- | ---- | ----- | ------- ||      |                   |      |       |         || NAME | STREET AND NUMBER | CITY | STATE | COUNTRY ||      |                   |      |       |         || NAME | STREET AND NUMBER | CITY | STATE | COUNTRY || NAME | STREET AND NUMBER | CITY | STATE | COUNTRY || NAME | STREET AND NUMBER | CITY | STATE | COUNTRY || NAME | STREET AND NUMBER | CITY | STATE | COUNTRY || NAME | STREET AND NUMBER | CITY | STATE | COUNTRY || NAME | STREET AND NUMBER | CITY | STATE | COUNTRY |SECTION 22. LANGUAGES-FOREIGN (STATE DEGREE OF PROFICIENCY AS "SLIGHT", "FAIR" OR "FLUENT" )| LANGUAGE | SPEAK | READ | WRITE |     || -------- | ----- | ---- | ----- | --- ||          |       |      |       |     || LANGUAGE | SPEAK | READ | WRITE |     ||          |       |      |       |     || LANGUAGE | SPEAK | READ | WRITE |     ||          |       |      |       |     || LANGUAGE | SPEAK | READ | WRITE |     ||          |       |      |       |     || LANGUAGE | SPEAK | READ | WRITE |     ||          |       |      |       |     || LANGUAGE | SPEAK | READ | WRITE |     ||          |       |      |       |     |