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<- -> C Û A dvprogram.state.gov/application.aspx ::: Сервисы U S. Department of State Bureau of Consular Affairs Electronic Diversity Visa Entry Form Electronic Diversity Visa Applicant Entry System: 12.7 О Help OMB Control Number: 1405-0153 Form: DS-5501 Expires: 08/31/2022 Estimated Burden: 30 minutes Part One - Entrant Information 1. Name Last/Family Name First Name Middle Name s_________________ tl________________________ О No First Name Q No Middle Name 2. Gender О Male О Female 3. Birth Date Month mm s_____________________- Day dd Year УУУУ 4. City Where You Were Born Enter Birth City Only. Do not enter District/County/Province/State. Birth City s________________________________________________________________________________________________________________- О Birth City Unknown 5. Country Where You Were Born
гендеры,США,страны,песочница,SJW
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