- Listing all relatives, (one generation both ways) living and dead.
- Mother's street address one year prior to your birth.
- Mother's employer at time of your birth, include address and duration of employment.
- Mother's doctor and dates of all her doctor appointments. (The form assumes only one doctor and does not explain what to do if your mother had three doctors during the course of her pregnancy with you.)
- A full description of the circumstances of your birth including listing the names, addresses, and phone numbers of all persons present during your birth.
- The street address and time of residence for every place you lived from the time of your birth to now.
- List all employers you have ever had in your life including the name of your supervisors and his/her phone numbers.
- Every school you ever attended throughout your life, including the street address of that school.
- Make one mistake and you risk fine and/or imprisonment for perjury.
The State Department says it will not cost anything to implement this form, meaning they have no intention to actually verify the information provided. The State Department only plans to require this form for selected individuals (i.e. everyone they want to deny passports to).
A wager: Hillary Clinton could not fill out this form completely without error in 45 minutes and I'm willing to bet $10,000 on that.