<!--
Copyright 1999-2004 Hostedware Corporation. All rights reserved.

All licensed and private-label versions of this application must retain this copyright notice intact on all pages.

All text, images, graphics, animations, and other materials on this website are subject to the copyrights and other intellectual property rights of Hostedware Corporation. 
These materials may not be copied for commercial use or distribution, nor may these materials be modified or reposted to other sites without prior written permission from Hostedware Corporation. 
This software application, its components, and all information and materials on the Hostedware web sites are provided "as is" and without warranty of any kind. 
Hostedware Corporation is located on the World Wide Web at http://www.hostedware.com.
For more information contact Hostedware Corporation, 16 Technology Dr Ste 116, Irvine, CA, 92618 USA. (800) 211-6967; (949) 585-1500.
-->

<!--
Copyright 1999-2004 Hostedware Corporation. All rights reserved.

All licensed and private-label versions of this application must retain this copyright notice intact on all pages.

All text, images, graphics, animations, and other materials on this website are subject to the copyrights and other intellectual property rights of Hostedware Corporation. 
These materials may not be copied for commercial use or distribution, nor may these materials be modified or reposted to other sites without prior written permission from Hostedware Corporation. 
This software application, its components, and all information and materials on the Hostedware web sites are provided "as is" and without warranty of any kind. 
Hostedware Corporation is located on the World Wide Web at http://www.hostedware.com.
For more information contact Hostedware Corporation, 16 Technology Dr Ste 116, Irvine, CA, 92618 USA. (800) 211-6967; (949) 585-1500.
-->
<!--
Copyright 1999-2004 Hostedware Corporation. All rights reserved.

All licensed and private-label versions of this application must retain this copyright notice intact on all pages.

All text, images, graphics, animations, and other materials on this website are subject to the copyrights and other intellectual property rights of Hostedware Corporation. 
These materials may not be copied for commercial use or distribution, nor may these materials be modified or reposted to other sites without prior written permission from Hostedware Corporation. 
This software application, its components, and all information and materials on the Hostedware web sites are provided "as is" and without warranty of any kind. 
Hostedware Corporation is located on the World Wide Web at http://www.hostedware.com.
For more information contact Hostedware Corporation, 16 Technology Dr Ste 116, Irvine, CA, 92618 USA. (800) 211-6967; (949) 585-1500.
-->

<!--
Copyright 1999-2004 Hostedware Corporation. All rights reserved.

All licensed and private-label versions of this application must retain this copyright notice intact on all pages.

All text, images, graphics, animations, and other materials on this website are subject to the copyrights and other intellectual property rights of Hostedware Corporation. 
These materials may not be copied for commercial use or distribution, nor may these materials be modified or reposted to other sites without prior written permission from Hostedware Corporation. 
This software application, its components, and all information and materials on the Hostedware web sites are provided "as is" and without warranty of any kind. 
Hostedware Corporation is located on the World Wide Web at http://www.hostedware.com.
For more information contact Hostedware Corporation, 16 Technology Dr Ste 116, Irvine, CA, 92618 USA. (800) 211-6967; (949) 585-1500.
--><!--
Copyright 1999-2004 Hostedware Corporation. All rights reserved.

All licensed and private-label versions of this application must retain this copyright notice intact on all pages.

All text, images, graphics, animations, and other materials on this website are subject to the copyrights and other intellectual property rights of Hostedware Corporation. 
These materials may not be copied for commercial use or distribution, nor may these materials be modified or reposted to other sites without prior written permission from Hostedware Corporation. 
This software application, its components, and all information and materials on the Hostedware web sites are provided "as is" and without warranty of any kind. 
Hostedware Corporation is located on the World Wide Web at http://www.hostedware.com.
For more information contact Hostedware Corporation, 16 Technology Dr Ste 116, Irvine, CA, 92618 USA. (800) 211-6967; (949) 585-1500.
-->

<!--
Copyright 1999-2004 Hostedware Corporation. All rights reserved.

All licensed and private-label versions of this application must retain this copyright notice intact on all pages.

All text, images, graphics, animations, and other materials on this website are subject to the copyrights and other intellectual property rights of Hostedware Corporation. 
These materials may not be copied for commercial use or distribution, nor may these materials be modified or reposted to other sites without prior written permission from Hostedware Corporation. 
This software application, its components, and all information and materials on the Hostedware web sites are provided "as is" and without warranty of any kind. 
Hostedware Corporation is located on the World Wide Web at http://www.hostedware.com.
For more information contact Hostedware Corporation, 16 Technology Dr Ste 116, Irvine, CA, 92618 USA. (800) 211-6967; (949) 585-1500.
-->
<!--
Copyright 1999-2004 Hostedware Corporation. All rights reserved.

All licensed and private-label versions of this application must retain this copyright notice intact on all pages.

All text, images, graphics, animations, and other materials on this website are subject to the copyrights and other intellectual property rights of Hostedware Corporation. 
These materials may not be copied for commercial use or distribution, nor may these materials be modified or reposted to other sites without prior written permission from Hostedware Corporation. 
This software application, its components, and all information and materials on the Hostedware web sites are provided "as is" and without warranty of any kind. 
Hostedware Corporation is located on the World Wide Web at http://www.hostedware.com.
For more information contact Hostedware Corporation, 16 Technology Dr Ste 116, Irvine, CA, 92618 USA. (800) 211-6967; (949) 585-1500.
-->

<!--
Copyright 1999-2004 Hostedware Corporation. All rights reserved.

All licensed and private-label versions of this application must retain this copyright notice intact on all pages.

All text, images, graphics, animations, and other materials on this website are subject to the copyrights and other intellectual property rights of Hostedware Corporation. 
These materials may not be copied for commercial use or distribution, nor may these materials be modified or reposted to other sites without prior written permission from Hostedware Corporation. 
This software application, its components, and all information and materials on the Hostedware web sites are provided "as is" and without warranty of any kind. 
Hostedware Corporation is located on the World Wide Web at http://www.hostedware.com.
For more information contact Hostedware Corporation, 16 Technology Dr Ste 116, Irvine, CA, 92618 USA. (800) 211-6967; (949) 585-1500.
-->
<!--
Copyright 1999-2004 Hostedware Corporation. All rights reserved.

All licensed and private-label versions of this application must retain this copyright notice intact on all pages.

All text, images, graphics, animations, and other materials on this website are subject to the copyrights and other intellectual property rights of Hostedware Corporation. 
These materials may not be copied for commercial use or distribution, nor may these materials be modified or reposted to other sites without prior written permission from Hostedware Corporation. 
This software application, its components, and all information and materials on the Hostedware web sites are provided "as is" and without warranty of any kind. 
Hostedware Corporation is located on the World Wide Web at http://www.hostedware.com.
For more information contact Hostedware Corporation, 16 Technology Dr Ste 116, Irvine, CA, 92618 USA. (800) 211-6967; (949) 585-1500.
-->

<!--
Copyright 1999-2004 Hostedware Corporation. All rights reserved.

All licensed and private-label versions of this application must retain this copyright notice intact on all pages.

All text, images, graphics, animations, and other materials on this website are subject to the copyrights and other intellectual property rights of Hostedware Corporation. 
These materials may not be copied for commercial use or distribution, nor may these materials be modified or reposted to other sites without prior written permission from Hostedware Corporation. 
This software application, its components, and all information and materials on the Hostedware web sites are provided "as is" and without warranty of any kind. 
Hostedware Corporation is located on the World Wide Web at http://www.hostedware.com.
For more information contact Hostedware Corporation, 16 Technology Dr Ste 116, Irvine, CA, 92618 USA. (800) 211-6967; (949) 585-1500.
--><!--
Copyright 1999-2004 Hostedware Corporation. All rights reserved.

All licensed and private-label versions of this application must retain this copyright notice intact on all pages.

All text, images, graphics, animations, and other materials on this website are subject to the copyrights and other intellectual property rights of Hostedware Corporation. 
These materials may not be copied for commercial use or distribution, nor may these materials be modified or reposted to other sites without prior written permission from Hostedware Corporation. 
This software application, its components, and all information and materials on the Hostedware web sites are provided "as is" and without warranty of any kind. 
Hostedware Corporation is located on the World Wide Web at http://www.hostedware.com.
For more information contact Hostedware Corporation, 16 Technology Dr Ste 116, Irvine, CA, 92618 USA. (800) 211-6967; (949) 585-1500.
-->
	
<!--
Copyright 1999-2004 Hostedware Corporation. All rights reserved.

All licensed and private-label versions of this application must retain this copyright notice intact on all pages.

All text, images, graphics, animations, and other materials on this website are subject to the copyrights and other intellectual property rights of Hostedware Corporation. 
These materials may not be copied for commercial use or distribution, nor may these materials be modified or reposted to other sites without prior written permission from Hostedware Corporation. 
This software application, its components, and all information and materials on the Hostedware web sites are provided "as is" and without warranty of any kind. 
Hostedware Corporation is located on the World Wide Web at http://www.hostedware.com.
For more information contact Hostedware Corporation, 16 Technology Dr Ste 116, Irvine, CA, 92618 USA. (800) 211-6967; (949) 585-1500.
-->
<!--
Copyright © 1999-2004 Hostedware Corporation. All rights reserved.

All licensed and private-label versions of this application must retain this copyright notice intact on all pages.

All text, images, graphics, animations, and other materials on this website are subject to the copyrights and other intellectual property rights of Hostedware Corporation. 
These materials may not be copied for commercial use or distribution, nor may these materials be modified or reposted to other sites without prior written permission from Hostedware Corporation. 
This software application, its components, and all information and materials on the Hostedware web sites are provided "as is" and without warranty of any kind. 
Hostedware Corporation is located on the World Wide Web at http://www.hostedware.com.
For more information contact Hostedware Corporation, 16 Technology Dr Ste 116, Irvine, CA, 92618 USA. (800) 211-6967; (949) 585-1500.
-->

<!--
Copyright © 1999-2004 Hostedware Corporation. All rights reserved.

All licensed and private-label versions of this application must retain this copyright notice intact on all pages.

All text, images, graphics, animations, and other materials on this website are subject to the copyrights and other intellectual property rights of Hostedware Corporation. 
These materials may not be copied for commercial use or distribution, nor may these materials be modified or reposted to other sites without prior written permission from Hostedware Corporation. 
This software application, its components, and all information and materials on the Hostedware web sites are provided "as is" and without warranty of any kind. 
Hostedware Corporation is located on the World Wide Web at http://www.hostedware.com.
For more information contact Hostedware Corporation, 16 Technology Dr Ste 116, Irvine, CA, 92618 USA. (800) 211-6967; (949) 585-1500.
-->
<Script src="application/JS/TakeSurvey.js"></Script>
<!--
Copyright © 1999-2004 Hostedware Corporation. All rights reserved.

All licensed and private-label versions of this application must retain this copyright notice intact on all pages.

All text, images, graphics, animations, and other materials on this website are subject to the copyrights and other intellectual property rights of Hostedware Corporation. 
These materials may not be copied for commercial use or distribution, nor may these materials be modified or reposted to other sites without prior written permission from Hostedware Corporation. 
This software application, its components, and all information and materials on the Hostedware web sites are provided "as is" and without warranty of any kind. 
Hostedware Corporation is located on the World Wide Web at http://www.hostedware.com.
For more information contact Hostedware Corporation, 16 Technology Dr Ste 116, Irvine, CA, 92618 USA. (800) 211-6967; (949) 585-1500.
-->
<SCRIPT LANGUAGE="JavaScript">

function checkChoice(field, i) {
if (i == field.length-1) { 
if (field[field.length-1].checked == true) {
for (i = 0; i < field.length-1; i++)
field[i].checked = false;
   }
}
else  { 
if (field[i].checked == true) {
field[field.length-1].checked = false;
	  }
   }
}
</script>
	
<html>
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		<META HTTP-EQUIV="Content-Type" CONTENT="text/html; charset=windows-1252">
		<title>Hosted Survey</title>
	</head>
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	&nbsp;<br>&nbsp;<br><center><font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif"><b>County of Shanta - Application for Certified Copy of Birth Record</b></font></font></font></center><br><img src='images/transparent.gif' width='1' height='2'><br>
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				<form action="takesurvey.asp" method="post" name="frmStartPage">
					<input type="hidden" name="demo" value="1"><p>
					<input type="hidden" name="SurveyID" value="8676">
					<input type="hidden" name="Test" value="">
					<input type="hidden" name="db" value="Hostedsurvey">
					<input type="hidden" name="httpReferer" value="">
					<input type="hidden" name="testId" value="">
					<input type="hidden" name="hostId" value="Hostedtest">
					
					<center>
					
					<input type="hidden" name="actCMD" value="Begin Survey">
					<input type="submit" name="btnBegin" value="Begin Survey">
					<br>&nbsp;<br></center>
					<font color="#000000"><font size=2><font face="Verdana,Arial,Helvetica,sans-serif">If you are resuming this survey, please enter your return code here:</font></font></font><input name="ReEnterID" size=20 maxlength=20>		
				</form> 
				
				</td>
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			</table></center>
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	</table>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; 
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	</body>
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<!--
Copyright © 1999-2004 Hostedware Corporation. All rights reserved.

All licensed and private-label versions of this application must retain this copyright notice intact on all pages.

All text, images, graphics, animations, and other materials on this website are subject to the copyrights and other intellectual property rights of Hostedware Corporation. 
These materials may not be copied for commercial use or distribution, nor may these materials be modified or reposted to other sites without prior written permission from Hostedware Corporation. 
This software application, its components, and all information and materials on the Hostedware web sites are provided "as is" and without warranty of any kind. 
Hostedware Corporation is located on the World Wide Web at http://www.hostedware.com.
For more information contact Hostedware Corporation, 16 Technology Dr Ste 116, Irvine, CA, 92618 USA. (800) 211-6967; (949) 585-1500.
-->