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NAME (Last, First, M.I.) 200 ITEM INSTRUCTIONS

S PLEASE USE A NO. 2 PENCIL ONLY
E ANSWER SHEET MAKE HEAVY BLACK MARKS THAT FILL THE CIRCLE COMPLETELY
X DO NOT MAKE ANY STRAY MARKS ON THIS ANSWER SHEET
@@@@@@@@~
KEY
SIDE 1
MAKE ALL ERASURES CLEANLY
10/12

~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ @@@@~~~~~~ ~
M A B C D E F EXAMPLES: PROPER MARK!@@@@@@~~~
IMPROPER MARKS •••••
•

~A
A ~A~A ~A ~A ~A
~A~A~A ~A ~A ~A ~A~A ~A~A
~A~A ~A ~ F ~ A B C D E A B C D E A B C D E A B C D E A B C D E
REORDER #20440-RR 10/12 A1841

~B
B ~B~B ~B ~B ~B
~B~B~B ~B ~B ~B ~B~B ~B~B
~B~B ~B ~ 112345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
11 21 31 41
www.apperson.com 800.827.9219

~C
C ~C~C ~C ~C ~C
~C~C~C ~C ~C ~C ~C~C ~C~C
~C~C ~C ~ G
R A B C D E A B C D E A B C D E A B C D E A B C D E
~D
D ~D~D ~D ~D ~D
~D~D~D ~D ~D ~D ~D~D ~D~D
~D~D ~D ~ A 212345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
12 22 32 42

~E
E ~E~E ~E ~E ~E
~E~E~E ~E ~E ~E ~E~E ~E~E
~E~E ~E ~ D
E A B C D E A B C D E A B C D E A B C D E A B C D E
~F
F ~F~F ~F ~F ~F
~F~F~F ~F ~F ~F ~F~F ~F~F
~F~F ~F ~ 312345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
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OR
13 23 33 43

~G
G ~G~G ~G ~G ~G
~G~G~G ~G ~G ~G ~G~G ~G~G
~G~G ~G ~ E A B C D E A B C D E A B C D E A B C D E A B C D E
~H
H ~H~H ~H ~H ~H
~H~H~H ~H ~H ~H ~H~H ~H~H
~H~H ~H ~ D
U
412345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
14 24 34 44

~I
I ~I~I ~I ~I ~I
~I~I~I ~I ~I ~I ~I~I ~I~I
~I~I ~I ~ C A B C D E A B C D E A B C D E A B C D E A B C D E
~J
J ~J~J ~J ~J ~J
~J~J~J ~J ~J ~J ~J~J ~J~J
~J~J ~J ~ 0 ~ 512345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
15 25 35 45

~K
K ~K~K ~K ~K ~K
~K~K~K ~K ~K ~K ~K~K ~K~K
~K~K ~K ~ 1 ~ A B C D E A B C D E A B C D E A B C D E A B C D E
~L
L ~L~L ~L ~L ~L
~L~L~L ~L ~L ~L ~L~L ~L~L
~L~L ~L ~ 2 ~ 612345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
16 26 36 46

~M
M ~M~M ~M ~M ~M
~M~M~M ~M ~M ~M ~M~M ~M~M
~M~M ~M ~ 3 ~ A B C D E A B C D E A B C D E A B C D E A B C D E
~N
N ~N~N ~N ~N ~N
~N~N~N ~N ~N ~N ~N~N ~N~N
~N~N ~N ~ 4 ~ 712345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
#20440 (Compatible #4521) www.apperson.com

17 27 37 47

~O
O ~O~O ~O ~O ~O
~O~O~O ~O ~O ~O ~O~O ~O~O
~O~O ~O ~ 5 ~ A B C D E A B C D E A B C D E A B C D E A B C D E
~P
P ~P~P ~P ~P ~P
~P~P~P ~P ~P ~P ~P~P ~P~P
~P~P ~P ~ 6 ~ 812345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
18 28 38 48

~Q
Q ~Q~Q ~Q ~Q ~Q
~Q~Q~Q ~Q ~Q ~Q ~Q~Q ~Q~Q
~Q~Q ~Q ~ 7 ~ A B C D E A B C D E A B C D E A B C D E A B C D E
~R
R ~R~R ~R ~R ~R
~R~R~R ~R ~R ~R ~R~R ~R~R
~R~R ~R ~ 8 ~ 912345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
19 29 39 49

~S
S ~S~S ~S ~S ~S
~S~S~S ~S ~S ~S ~S~S ~S~S
~S~S ~S ~ 9 ~ A B C D E A B C D E A B C D E A B C D E A B C D E
~T
T ~T~T ~T ~T ~T
~T~T~T ~T ~T ~T ~T~T ~T~T
~T~T ~T ~ ~ 10 1012345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
20 30 40 50

~U
U ~U~U ~U ~U ~U
~U~U~U ~U ~U ~U ~U~U ~U~U
~U~U ~U ~ ~ 11

~V
V ~V~V ~V ~V ~V
~V~V~V ~V ~V ~V ~V~V ~V~V
~V~V ~V ~ ~ 12
A B C D E A B C D E A B C D E A B C D E A B C D E
~W
W ~W~W ~W ~W ~W
~W~W~W ~W ~W ~W ~W~W ~W~W
~W~W ~W ~ ~ 13 5112345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
61 71 81 91

~X
X ~X~X ~X ~X ~X
~X~X~X ~X ~X ~X ~X~X ~X~X
~X~X ~X ~ ~ 14
A B C D E A B C D E A B C D E A B C D E A B C D E
REORDER

~Y
Y ~Y~Y ~Y ~Y ~Y
~Y~Y~Y ~Y ~Y ~Y ~Y~Y ~Y~Y
~Y~Y ~Y ~ ~ 15 5212345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
62 72 82 92

~Z
Z ~Z~Z ~Z ~Z ~Z
~Z~Z~Z ~Z ~Z ~Z ~Z~Z ~Z~Z
~Z~Z ~Z ~ ~ 16
A B C D E A B C D E A B C D E A B C D E A B C D E
5312345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
63 73 83 93
BIRTH DATE IDENTIFICATION NUMBER SPECIAL CODES
A B C D E A B C D E A B C D E A B C D E A B C D E
MO. DAY YR. A B C D E F G H I J K L M N O P 12345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
54 64 74 84 94

~ Jan.
A B C D E A B C D E A B C D E A B C D E A B C D E
~ Feb.
12345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
55 65 75 85 95
Mar.
~0~0~0~0
~0~0
~0~0
~0~0
~0~0
~0~0
~0~0
~0~0
~0~0
~ A B C D E A B C D E A B C D E A B C D E A B C D E
~1~1~1~1
~1~1
~1~1
~1~1
~1~1
~1~1
~1~1
~1~1
~1~1
~ 12345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
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Apr. 56 66 76 86 96
May
~2~2~2~2
~2~2
~2~2
~2~2
~2~2
~2~2
~2~2
~2~2
~2~2
~ A B C D E A B C D E A B C D E A B C D E A B C D E
Jun.
~3~3~3~3
~3~3
~3~3
~3~3
~3~3
~3~3
~3~3
~3~3
~3~3
~ 12345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
57 67 77 87 97
Jul.
~@4 ~4~4
~4~4
~4~4
~4~4
~4~4
~4~4
~4~4
~4~4
~4~4
~ A B C D E A B C D E A B C D E A B C D E A B C D E
Aug.
~@5 ~5~5
~5~5
~5~5
~5~5
~5~5
~5~5
~5~5
~5~5
~5~5
~ 12345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
58 68 78 88 98
Sep.
~@6 ~6~6
~6~6
~6~6
~6~6
~6~6
~6~6
~6~6
~6~6
~6~6
~ A B C D E A B C D E A B C D E A B C D E A B C D E
[ Oct. ~ @ 7
~7~7
~7~7
~7~7
~7~7
~7~7
~7~7
~7~7
~7~7
~7~7
~ 12345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
59 69 79 89 99
Nov.
~@8 ~8~8
~8~8
~8~8
~8~8
~8~8
~8~8
~8~8
~8~8
~8~8
~ A B C D E A B C D E A B C D E A B C D E A B C D E
[ Dec. ~ @ 9
~9~9
~9~9
~9~9
~9~9
~9~9
~9~9
~9~9
~9~9
~9~9
~ 12345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
60 70 80 90 100
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 aab
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INSTRUCTIONS
200 ITEM PLEASE USE A NO. 2 PENCIL ONLY
MAKE HEAVY BLACK MARKS THAT FILL THE CIRCLE COMPLETELY
ANSWER SHEET DO NOT MAKE ANY STRAY MARKS ON THIS ANSWER SHEET
MAKE ALL ERASURES CLEANLY
SIDE 2
EXAMPLES: PROPER MARK !@@@@@@~~~
IMPROPER MARKS ••••

A B C D E A B C D E A B C D E A B C D E A B C D E
101 12345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
111 121 131 141

A B C D E A B C D E A B C D E A B C D E A B C D E
102 12345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
112 122 132 142

103
A B C D E
113

A B C D E
123
A B C D E
12345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
133 143

A B C D E
A B C D E

A B C D E
A B C D E

A B C D E
A B C D E

A B C D E
DO
104 12345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
114 124 134 144
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A B C D E A B C D E A B C D E A B C D E A B C D E
105 12345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
115 125 135 145

106
A B C D E A B C D E
12345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
116 126 136 146
A B C D E A B C D E A B C D E
NOT
A B C D E A B C D E A B C D E A B C D E A B C D E
107 12345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
117 127 137 147

A B C D E A B C D E A B C D E A B C D E A B C D E
108

109
12345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
118

A B C D E
128 138 148

A B C D E
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
12345@@12345@@12345@@12345@@12345
119 129
A B C D E
139
A B C D E
149
A B C D E WRITE
A B C D E A B C D E A B C D E A B C D E A B C D E
110 12345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
120 130 140 150

151
A B C D E A B C D E
12345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
161 171 181 191
A B C D E A B C D E A B C D E IN
A B C D E A B C D E A B C D E A B C D E A B C D E
152 12345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
162 172 182 192

SHADED
A B C D E A B C D E A B C D E A B C D E A B C D E
153 12345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
163 173 183 193

A B C D E A B C D E A B C D E A B C D E A B C D E
154 12345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
164 174 184 194

A B C D E A B C D E A B C D E A B C D E A B C D E
12345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
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155 165 175 185 195

156
A B C D E A B C D E
12345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
166 176 186 196
A B C D E A B C D E A B C D E
AREA
A B C D E A B C D E A B C D E A B C D E A B C D E
157 12345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
167 177 187 197

A B C D E A B C D E A B C D E A B C D E A B C D E
158 12345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
168 178 188 198

A B C D E A B C D E A B C D E A B C D E A B C D E
159 12345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
169 179 189 199

A B C D E A B C D E A B C D E A B C D E A B C D E [
160 12345@@12345@@12345@@12345@@12345
~~~~~@@~~~~~@@~~~~~@@~~~~~@@~~~~~
170 180 190 200

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