document.write('<option value="none">Select...</option>');
	document.write('<option value="Out of State">Out of State</option>');
	document.write('<option value="Adams">Adams</option>');
	document.write('<option value="Allegheny">Allegheny</option>');
	document.write('<option value="Armstrong">Armstrong</option>');
	document.write('<option value="Beaver">Beaver</option>');
	document.write('<option value="Bedford">Bedford</option>');
	document.write('<option value="Berks">Berks</option>');
	document.write('<option value="Blair">Blair</option>');
	document.write('<option value="Bradford">Bradford</option>');
	document.write('<option value="Bucks">Bucks</option>');
	document.write('<option value="Butler">Butler</option>');
	document.write('<option value="Cambria">Cambria</option>');
	document.write('<option value="Cameron">Cameron</option>');
	document.write('<option value="Carbon">Carbon</option>');
	document.write('<option value="Centre">Centre</option>');
	document.write('<option value="Chester">Chester</option>');
	document.write('<option value="Clarion">Clarion</option>');
	document.write('<option value="Clearfield">Clearfield</option>');
	document.write('<option value="Clinton">Clinton</option>');
	document.write('<option value="Columbia">Columbia</option>');
	document.write('<option value="Crawford">Crawford</option>');
	document.write('<option value="Cumberland">Cumberland</option>');
	document.write('<option value="Dauphin">Dauphin</option>');
	document.write('<option value="Delaware">Delaware</option>');
	document.write('<option value="Elk">Elk</option>');
	document.write('<option value="Erie">Erie</option>');
	document.write('<option value="Fayette">Fayette</option>');
	document.write('<option value="Forest">Forest</option>');
	document.write('<option value="Franklin">Franklin</option>');
	document.write('<option value="Fulton">Fulton</option>');
	document.write('<option value="Greene">Greene</option>');
	document.write('<option value="Huntingdon">Huntingdon</option>');
	document.write('<option value="Indiana">Indiana</option>');
	document.write('<option value="Jefferson">Jefferson</option>');
	document.write('<option value="Juniata">Juniata</option>');
	document.write('<option value="Lackawanna">Lackawanna</option>');
	document.write('<option value="Lancaster">Lancaster</option>');
	document.write('<option value="Lawrence">Lawrence</option>');
	document.write('<option value="Lebanon">Lebanon</option>');
	document.write('<option value="Lehigh">Lehigh</option>');
	document.write('<option value="Luzerne">Luzerne</option>');
	document.write('<option value="Lycoming">Lycoming</option>');
	document.write('<option value="McKean">McKean</option>');
	document.write('<option value="Mercer">Mercer</option>');
	document.write('<option value="Mifflin">Mifflin</option>');
	document.write('<option value="Monroe">Monroe</option>');
	document.write('<option value="Montgomery">Montgomery</option>');
	document.write('<option value="Montour">Montour</option>');
	document.write('<option value="Northampton">Northampton</option>');
	document.write('<option value="Northumberland">Northumberland</option>');
	document.write('<option value="Perry">Perry</option>');
	document.write('<option value="Philadelphia">Philadelphia</option>');
	document.write('<option value="Pike">Pike</option>');
	document.write('<option value="Potter">Potter</option>');
	document.write('<option value="Schuylkill">Schuylkill</option>');
	document.write('<option value="Snyder">Snyder</option>');
	document.write('<option value="Somerset">Somerset</option>');
	document.write('<option value="Sullivan">Sullivan</option>');
	document.write('<option value="Susquehanna">Susquehanna</option>');
	document.write('<option value="Tioga">Tioga</option>');
	document.write('<option value="Union">Union</option>');
	document.write('<option value="Venango">Venango</option>');
	document.write('<option value="Warren">Warren</option>');
	document.write('<option value="Washington">Washington</option>');
	document.write('<option value="Wayne">Wayne</option>');
	document.write('<option value="Westmoreland">Westmoreland</option>');
	document.write('<option value="Wyoming">Wyoming</option>');
	document.write('<option value="York">York</option>');