--- /dev/null
+
+ <TR>
+ <TH ALIGN="right" VALIGN="center"><% mt('Address') |h %></TH>
+ <TD><INPUT TYPE="text" NAME="address" SIZE=54></TD>
+ </TR>
+
+ <TR>
+ <TH ALIGN="right" VALIGN="center"><% mt('City') |h %></TH>
+ <TD>
+ <& /elements/city.html,
+ disable_empty => 0,
+ empty_label => '(all)',
+ disable_text => 1,
+ &>
+ </TD>
+ </TR>
+
+ <TR>
+ <TH ALIGN="right" VALIGN="center"><% mt('County') |h %></TH>
+ <TD>
+ <& /elements/select-county.html,
+ disable_empty => 0,
+ empty_label => '(all)',
+ &>
+ </TD>
+ </TR>
+
+ <TR>
+ <TH ALIGN="right" VALIGN="center"><% mt('State') |h %></TH>
+ <TD>
+ <& /elements/select-state.html,
+ disable_empty => 0,
+ empty_label => '(all)',
+ &>
+ </TD>
+ </TR>
+
+ <TR>
+ <TH ALIGN="right" VALIGN="center"><% mt('Zip') |h %></TH>
+ <TD><INPUT TYPE="text" NAME="zip" SIZE=12></TD>
+ </TR>
+
+ <TR>
+ <TH ALIGN="right" VALIGN="center"><% mt('Country') |h %></TH>
+ <TD>
+ <& /elements/select-country.html,
+ disable_empty => 0,
+ state_disable_empty => 0,
+ state_empty_label => '(all)',
+ &>
+ </TD>
+ </TR>
+
+ <TR>
+ <TH ALIGN="right" VALIGN="center"><% mt('Search historical addresses') %></TH>
+ <TD><INPUT TYPE="checkbox" NAME="location_history" VALUE="1"></TD>
+
+