This government document is issued by City of Porterville for use in Porterville, CA
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https://www.google.com/url?client=internal-element-cse&cx=ac03cb6defe71343b&q=https://www.ci.porterville.ca.us/Entry%2520Field%2520Intake%2520Form%2520English%2520-%2520FILLABLE%2520TEMP%2520FILL%2520OUT%2520COMPLETELY.pdf&sa=U&ved=2ahUKEwia05PljfX3AhXeSPEDHYXnAJk4ChAWegQIBRAB&usg=AOvVaw2vdk4a0NDjkSr7JIKG63Aa