21

20

19

18

17

16

15

14

13C

13B

13A

12

11

10

SSN2

NAM2

ADDR

PNAM

DISB

DISA

DIS

DATE

NDP

PS

STX

ST

FS9

FS8

FS7

FS6

FS5

FS4

FS3

FS2

FS1

FS

SSN

NAME

NONE