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%div.page#page_1
#logo= image_tag(@logo_image_path)
%h1.title= I18n.t('pdf.nvra.page1.title').html_safe
%h2.subtitle= I18n.t('pdf.nvra.page1.subtitle' ).html_safe
%p.top_paragraph= I18n.t('pdf.nvra.page1.top_paragraph' ).html_safe
%table#instructions_table
%tr
%td.instructions_block{:rowspan=>3}
%h4= I18n.t('pdf.nvra.page1.instructions_block.title' ).html_safe
%p= I18n.t('pdf.nvra.page1.instructions_block.subtitle' ).html_safe
%ol
%li= I18n.t('pdf.nvra.page1.instructions_block.step1' ).html_safe
%li
= I18n.t('pdf.nvra.page1.instructions_block.step2' ).html_safe
.mailer
.instructions= I18n.t('pdf.nvra.page1.instructions_block.step2mailer' ).html_safe
.image= wicked_pdf_image_tag("pdf/mailer.png")
%li= I18n.t('pdf.nvra.page1.instructions_block.step3' ).html_safe
%li= I18n.t('pdf.nvra.page1.instructions_block.step4' ).html_safe
%li= I18n.t('pdf.nvra.page1.instructions_block.step5' ).html_safe
%td.submit_block
- if !@registrant.home_state_pdf_instructions.blank?
.state_instructions
%p= @registrant.home_state_pdf_instructions.html_safe
%h4.title= I18n.t('pdf.nvra.page1.submit_block.title' ).html_safe
%p= @state.registrar_address.to_s.html_safe
%tr
%td.deadline_block
%h4.title= I18n.t('pdf.nvra.page1.deadline_block.title' ).html_safe
%p= @registrant.registration_deadline.to_s.html_safe
%tr
%td.other_block
%h4.title= I18n.t('pdf.nvra.page1.other_block', :instructions_url=>@registrant_instructions_link).html_safe
%h3.bottom_title= I18n.t('pdf.nvra.page1.bottom_block.title' ).html_safe
%p= I18n.t('pdf.nvra.page1.bottom_block.paragraph1' ).html_safe
%p= I18n.t('pdf.nvra.page1.bottom_block.paragraph2' ).html_safe
%p= I18n.t('pdf.nvra.page1.bottom_block.paragraph3' ).html_safe
%p= I18n.t('pdf.nvra.page1.bottom_block.paragraph4' ).html_safe
.page#page_2
%h1.title= form_prompt('pdf.nvra.page2.title' ).html_safe
%h2.subtitle= form_prompt('pdf.nvra.page2.subtitle' ).html_safe
%table.form
%tr#topblock{:class=>"#{non_english? ? 'smaller_prompts' : ''}"}
%td.items
.item1#us_citizen
= form_prompt('pdf.nvra.page2.topblock.item1' ).html_safe
%span.value= @registrant.yes_no_us_citizen?
.item2#will_be_18_by_election
= form_prompt('pdf.nvra.page2.topblock.item2' ).html_safe
%span.value= @registrant.yes_no_will_be_18_by_election?
.item3= form_prompt('pdf.nvra.page2.topblock.item3' ).html_safe
.item4= form_prompt('pdf.nvra.page2.topblock.item4' ).html_safe
%td.fouo= form_prompt('pdf.nvra.page2.topblock.fouo' ).html_safe
%table.form
%tr#block1
%td.block_number 1
%td.box1#name_title
.label= form_prompt('pdf.nvra.page2.block1.box1_label' ).html_safe
.value.checkboxes
.checkbox-col
.checkbox{:class=>checked?(:mr, :name_title) ? 'checkbox-checked' : ''}
= checkbox(:mr, :name_title)
%span= I18n.t("txt.registration.titles.mr", :locale=>:en)
.checkbox{:class=>checked?(:mrs, :name_title) ? 'checkbox-checked' : ''}
= checkbox(:mrs, :name_title)
%span= I18n.t("txt.registration.titles.mrs", :locale=>:en)
.checkbox-col
.checkbox{:class=>checked?(:miss, :name_title) ? 'checkbox-checked' : ''}
= checkbox(:miss, :name_title)
%span= I18n.t("txt.registration.titles.miss", :locale=>:en)
.checkbox{:class=>checked?(:ms, :name_title) ? 'checkbox-checked' : ''}
= checkbox(:ms, :name_title)
%span= I18n.t("txt.registration.titles.ms", :locale=>:en)
%td.box2#name_last
.label= form_prompt('pdf.nvra.page2.block1.box2_label' ).html_safe
.value= @registrant.last_name
%td.box3#name_first
.label= form_prompt('pdf.nvra.page2.block1.box3_label' ).html_safe
.value= @registrant.first_name
%td.box4#name_middle
.label= form_prompt('pdf.nvra.page2.block1.box4_label' ).html_safe
.value= @registrant.middle_name
%td.box5#name_suffix
.label= form_prompt('pdf.nvra.page2.block1.box5_label' ).html_safe
.value.checkboxes.suffix-checkboxes
.checkbox-col
.checkbox{:class=>checked?(:jr, :name_suffix) ? 'checkbox-checked' : ''}
= checkbox(:jr, :name_suffix)
%span= I18n.t("txt.registration.suffixes.jr", :locale=>:en)
.checkbox{:class=>checked?(:sr, :name_suffix) ? 'checkbox-checked' : ''}
= checkbox(:sr, :name_suffix)
%span= I18n.t("txt.registration.suffixes.sr", :locale=>:en)
.checkbox-col
.checkbox{:class=>checked?(:ii, :name_suffix) ? 'checkbox-checked' : ''}
= checkbox(:ii, :name_suffix)
%span= I18n.t("txt.registration.suffixes.ii", :locale=>:en)
.checkbox{:class=>checked?(:iii, :name_suffix) ? 'checkbox-checked' : ''}
= checkbox(:iii, :name_suffix)
%span= I18n.t("txt.registration.suffixes.iii", :locale=>:en)
.checkbox{:class=>checked?(:iv, :name_suffix) ? 'checkbox-checked' : ''}
= checkbox(:iv, :name_suffix)
%span= I18n.t("txt.registration.suffixes.iv", :locale=>:en)
%table.form
%tr#block2
%td.block_number 2
%td.box1#home_address_street
.label= form_prompt('pdf.nvra.page2.block2.box1_label' ).html_safe
.value= @registrant.home_address
%td.box2#home_address_unit
.label= form_prompt('pdf.nvra.page2.block2.box2_label' ).html_safe
.value= @registrant.home_unit
%td.box3#home_address_city
.label= form_prompt('pdf.nvra.page2.block2.box3_label' ).html_safe
.value= @registrant.home_city
%td.box4#home_address_state
.label= form_prompt('pdf.nvra.page2.block2.box4_label' ).html_safe
.value= @registrant.home_state_abbrev
%td.box5#home_address_zip_code
.label= form_prompt('pdf.nvra.page2.block2.box5_label' ).html_safe
.value= @registrant.home_zip_code
%tr#block3
%td.block_number 3
%td.box1#mailing_address_street{:colspan=>2}
.label= form_prompt('pdf.nvra.page2.block3.box1_label' ).html_safe
.value= "#{@registrant.mailing_address} #{@registrant.mailing_unit}"
%td.box2#mailing_address_city
.label= form_prompt('pdf.nvra.page2.block3.box2_label' ).html_safe
.value= @registrant.mailing_city
%td.box3#mailing_address_state
.label= form_prompt('pdf.nvra.page2.block3.box3_label' ).html_safe
.value= @registrant.mailing_state_abbrev
%td.box4#mailing_address_zip_code
.label= form_prompt('pdf.nvra.page2.block3.box4_label' ).html_safe
.value= @registrant.mailing_zip_code
%table.form
%tr#block4
%td.block4.block_number 4
%td.block4.box1#date_of_birth
%table.inner_form
%tr
%td.label= form_prompt('pdf.nvra.page2.block4.box1_label' ).html_safe
%td.item2
.value= @registrant.pdf_date_of_birth_month + ' /'
.label=form_prompt('pdf.nvra.page2.block4.item2' ).html_safe
%td.item3
.value= @registrant.pdf_date_of_birth_day + ' /'
.label=form_prompt('pdf.nvra.page2.block4.item3' ).html_safe
%td.item4
.value= @registrant.pdf_date_of_birth_year
.label=form_prompt('pdf.nvra.page2.block4.item4' ).html_safe
%td.block5.block_number 5
%td.block5.box1#phone_number
.label= form_prompt('pdf.nvra.page2.block5' ).html_safe
.value= @registrant.phone
%td.block6.block_number{:rowspan=>2} 6
%td.block6.box1#id_number{:rowspan=>2}
.label= form_prompt('pdf.nvra.page2.block6.box1_label' ).html_safe
.sublabel= form_prompt('pdf.nvra.page2.block6.box1_sublabel' ).html_safe
.value= @registrant.state_id_number
%tr#block7
%td.block7.block_number 7
%td.block7.box1#party
.label= form_prompt('pdf.nvra.page2.block7.box1_label' ).html_safe
.sublabel= form_prompt('pdf.nvra.page2.block7.box1_sublabel' ).html_safe
.value
= @registrant.english_party_name
- if non_english? && !@registrant.party.blank?
.translated_value= "/ #{@registrant.party}"
%td.block8.block_number 8
%td.block8.box1#race
.label= form_prompt('pdf.nvra.page2.block8.box1_label' ).html_safe
.sublabel= form_prompt('pdf.nvra.page2.block8.box1_sublabel' ).html_safe
.value
= @registrant.pdf_english_race
%table.form
%tr#block9
%td.block_number 9
%td.box1
.affirmation_header= form_prompt('pdf.nvra.page2.block9.affirmation_header' ).html_safe
%ul.affirmations
%li.affirmation_1= form_prompt('pdf.nvra.page2.block9.affirmation_1' ).html_safe
%li.affirmation_2= form_prompt('pdf.nvra.page2.block9.affirmation_2' ).html_safe
%li.affirmation_3= form_prompt('pdf.nvra.page2.block9.affirmation_3' ).html_safe
%td.box2
.signature_box= wicked_pdf_image_tag("pdf/signature_box.png")
.please_sign= form_prompt('pdf.nvra.page2.block9.please_sign' ).html_safe
.signature_date
.date= form_prompt('pdf.nvra.page2.block9.date' ).html_safe
.date_box= wicked_pdf_image_tag("pdf/date_box.png")
.month= form_prompt('pdf.nvra.page2.block9.month' ).html_safe
.day= form_prompt('pdf.nvra.page2.block9.day' ).html_safe
.year= form_prompt('pdf.nvra.page2.block9.year' ).html_safe
%h4.top_half_footer
= form_prompt('pdf.nvra.page2.top_half_footer' ).html_safe
.bottom_half
.pdf_barcode= @registrant.pdf_barcode
%h3.bottom_half_title
= form_prompt('pdf.nvra.page2.bottom_half_title' ).html_safe
%p.block_title.blockA= form_prompt('pdf.nvra.page2.blockA.title' ).html_safe
%table.form
%tr#blockA
%td.block_number A
%td.box1#prev_name_title
.label= form_prompt('pdf.nvra.page2.blockA.box1_label' ).html_safe
.value.checkboxes
.checkbox-col
.checkbox{:class=>checked?(:mr, :prev_name_title) ? 'checkbox-checked' : ''}
= checkbox(:mr, :prev_name_title)
%span= I18n.t("txt.registration.titles.mr", :locale=>:en)
.checkbox{:class=>checked?(:mrs, :prev_name_title) ? 'checkbox-checked' : ''}
= checkbox(:mrs, :prev_name_title)
%span= I18n.t("txt.registration.titles.mrs", :locale=>:en)
.checkbox-col
.checkbox{:class=>checked?(:miss, :prev_name_title) ? 'checkbox-checked' : ''}
= checkbox(:miss, :prev_name_title)
%span= I18n.t("txt.registration.titles.miss", :locale=>:en)
.checkbox{:class=>checked?(:ms, :prev_name_title) ? 'checkbox-checked' : ''}
= checkbox(:ms, :prev_name_title)
%span= I18n.t("txt.registration.titles.ms", :locale=>:en)
%td.box2#prev_name_last
.label= form_prompt('pdf.nvra.page2.blockA.box2_label' ).html_safe
.value= @registrant.prev_last_name
%td.box3#prev_name_first
.label= form_prompt('pdf.nvra.page2.blockA.box3_label' ).html_safe
.value= @registrant.prev_first_name
%td.box4#prev_name_middle
.label= form_prompt('pdf.nvra.page2.blockA.box4_label' ).html_safe
.value= @registrant.prev_middle_name
%td.box5#prev_name_suffix
.label= form_prompt('pdf.nvra.page2.blockA.box5_label' ).html_safe
.value.checkboxes.suffix-checkboxes
.checkbox-col
.checkbox{:class=>checked?(:jr, :prev_name_suffix) ? 'checkbox-checked' : ''}
= checkbox(:jr, :prev_name_suffix)
%span= I18n.t("txt.registration.suffixes.jr", :locale=>:en)
.checkbox{:class=>checked?(:sr, :prev_name_suffix) ? 'checkbox-checked' : ''}
= checkbox(:sr, :prev_name_suffix)
%span= I18n.t("txt.registration.suffixes.sr", :locale=>:en)
.checkbox-col
.checkbox{:class=>checked?(:ii, :prev_name_suffix) ? 'checkbox-checked' : ''}
= checkbox(:ii, :prev_name_suffix)
%span= I18n.t("txt.registration.suffixes.ii", :locale=>:en)
.checkbox{:class=>checked?(:iii, :prev_name_suffix) ? 'checkbox-checked' : ''}
= checkbox(:iii, :prev_name_suffix)
%span= I18n.t("txt.registration.suffixes.iii", :locale=>:en)
.checkbox{:class=>checked?(:iv, :prev_name_suffix) ? 'checkbox-checked' : ''}
= checkbox(:iv, :prev_name_suffix)
%span= I18n.t("txt.registration.suffixes.iv", :locale=>:en)
%p.block_title.blockB= form_prompt('pdf.nvra.page2.blockB.title' ).html_safe
%table.form
%tr#blockB
%td.block_number B
%td.box1#prev_address_street
.label= form_prompt('pdf.nvra.page2.blockB.box1_label' ).html_safe
.value= @registrant.prev_address
%td.box2#prev_address_unit
.label= form_prompt('pdf.nvra.page2.blockB.box2_label' ).html_safe
.value= @registrant.prev_unit
%td.box3#prev_address_city
.label= form_prompt('pdf.nvra.page2.blockB.box3_label' ).html_safe
.value= @registrant.prev_city
%td.box4#prev_address_state
.label= form_prompt('pdf.nvra.page2.blockB.box4_label' ).html_safe
.value= @registrant.prev_state_abbrev
%td.box5#prev_address_zip_code
.label= form_prompt('pdf.nvra.page2.blockB.box5_label' ).html_safe
.value= @registrant.prev_zip_code
%p.block_title.blockC= form_prompt('pdf.nvra.page2.blockC.title' ).html_safe
%table.form
%tr#blockC
%td.block_number C
%td.box1
.address_map_wrapper
.address_map= wicked_pdf_image_tag("pdf/address_map.png")
%ul.instructions
%li= form_prompt('pdf.nvra.page2.blockC.instructions.bullet1' ).html_safe
%li= form_prompt('pdf.nvra.page2.blockC.instructions.bullet2' ).html_safe
%li= form_prompt('pdf.nvra.page2.blockC.instructions.bullet3' ).html_safe
.example.label= I18n.t('pdf.nvra.page2.blockC.example.title' ).html_safe
.example.store= form_prompt('pdf.nvra.page2.blockC.example.grocery_store' ).html_safe
.example.school= form_prompt('pdf.nvra.page2.blockC.example.public_school' ).html_safe
.example.street1= I18n.t('pdf.nvra.page2.blockC.example.street1', :locale=>:en).html_safe
.example.street2= I18n.t('pdf.nvra.page2.blockC.example.street2', :locale=>:en).html_safe
.north= form_prompt('pdf.nvra.page2.blockC.north' ).html_safe
%p.block_title.blockD= form_prompt('pdf.nvra.page2.blockD.title' ).html_safe
%table.form
%tr#blockD
%td.block_number D
%td.box1
.value
%h4.bottom_half_footer
= form_prompt('pdf.nvra.page2.bottom_half_footer' ).html_safe
.page#page_3
#page_3_wrapper
#page_3_background= wicked_pdf_image_tag("pdf/page_3.png")
%h1= form_prompt('pdf.nvra.page3.fouo' ).html_safe
#address
.line.line1= @state.registrar_address.to_s.html_safe
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