000008                                                                                                                                                                                                                                                                                                                                                            *
17,4  217,122  12 12,0 1;31;40  TITLE                         0300000yNL nanXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                            Enter Job Title Here                                                                                                                                                                                        *
17,6  217,184  12 12,0 1;31;40  NAME                          30 0   nnL nanXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                            Enter LastName, FirstName                                                                                                                                                                                   *
17,8  217,245  12 12,0 1;31;40  STREET-ADDRESS                30 0   nnL nanXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                            Enter Street Address - Include Apartment Number                                                                                                                                                             *
17,10 217,307  12 12,0 1;31;40  CITY                          20 0   nnl nayXXXXXXXXXXXXXXXXXXXX                                                      Enter City Here                                                                                                                                                                                             *
17,12 217,368  12 12,0 1;31;40  STATE                         2      nnl NANXX                                                                        Enter two character State code                                                                                                                                                                              *
17,14 217,430  12 12,0 1;31;40  zip-5                         5      NNl NAN99999                                                                     Enter 5 Digit Zip Code                                                                                                                                                                                      *
23,14 294,430  12 12,0 1;31;40  zip-4                         4      NNl NAN9999                                                                      Enter 4 Digit Zip-Dash code                                                                                                                                                                                 *
17,16 217,491  12 12,0 1;31;40  Miscellaneous-code            10     NNl NANxxxxxxxxxx                                                                Enter Membership Code                                                                                                                                                                                       *
                                                                                                                  