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D Place of Birth :ti>t 1JtiiE itt:;fD %~q Type and No. of Passport or ill. ~ 0 fi lTR~ ~K~~~ Tel. ( !fj/M o -9:.1 F !:f ffij/Chinese 0 ~ 001 American 0 Nationality Occupation o ­ ) JilffiJtl!.:laI: Mail Address ~ pJ;g ~, Jtl!.!1l:: ( lj(J~ 0 nj)( itt: Company Name and Address (Business Documents Only) )(1tt:tE$1~fflB<J § B<J Purpose of Document to Be Used in China 0 0 o o ®loffl Adoption o ~~/Marriage o *offlFosterage mF$t?ir, ~~/House Property Transfe.

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