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. Shopping Mall 2. . Discount Store 3. . Specialty Store BR Baby’s date of birth: (or due date) Month Day Year BS Date of Your birth: Month Day Year BT For your primary residence, do you: 1. . Own? 2. . Rent? BU Your marital status: 1. . Married 2. . Single CL Education (Please check which category applies): 1. . High School 3. . Completed College 2. . Some College 4. . Graduate School CM Including yourself, what is the total number of people living in your household? (Examples: 01, 02, 03, 04..