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? Please select one. Unknown/Decline to state Decline to state. Asian Origins in any of the original peoples of the Far East, Southeast Asia, or the India subcontinent, including for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam. Black or African American Origins in any of the black racial groups of Africa American Indian or Alaska Native Origins in any of the original peoples of North or South American, including Central Americ.

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