The doc shows birthplace of both parents, no current address for either.
Residence seems to be for City.State/Country. Not address.
Third line has space for Residence of Mother and Birthplace of Mother
The Fourth Line has a space for Birthplace of father, but not Residence of Father. It also has spaces for Occupations of both Mother and Father.
It is curious that the Residence of the father would not be documented as well.