anchor.diff:        input(type='text', id='lastname', name='lastname', class='form-control', placeholder='Enter Last Name', required)
         input(type='text', id='streetaddress1', name='streetaddress1', class='form-control', placeholder='Address 1', required)      
         input(type='text', id='city', name='city', class='form-control', placeholder='City', required)
  -      input(type='text', id='address_zip_5', name='address_zip_5', class='form-control', required)
  +      input(type='text', id='address_zip_5', name='address_zip_5', class='form-control', placeholder='Zip', required)
         input(type='text', id='phone', name='phone', class='form-control', placeholder='Phone', required)
         select(name="state")#state
           option(value='') Select One
  
positive.code:       h4 Topic
        select(name="topic", required)#topic
          option(value='') Select One	  
          option Addiction Services
          option Agriculture
          option Arts and History
          option Banking
          option Birth/Death Certificates
          option Business
          option Children and Families
          option Child Support
          option Civil Service Commission
          option Consumer Affairs
          option Corrections
          option Developmental Disabilities
          option Division on Elections
          option Education
          option Environment
          option Family Care/Medicaid
          option Health
          option Housing
          option Human Services
          option Insurance
          option Invitations/Scheduling
          option Labor
          option Law and Public Safety
          option Licensing Boards
          option Lottery
          option Mental Health Services
          option Military and Veterans Affairs
          option Pensions and Retirements
          option Public Utilities
          option Requesting Proclamations / Special Letter
          option Superstorm Sandy/CDBG
          option Taxation
          option Temporary Disability
          option Transportation / Motor Vehicles
          option Unclaimed Property
          option Unemployment
        br
        br
        input(type='submit', id='submit', name='submit', value='Submit', class='btn btn-default')
  
negative.code: 
    form(method='POST', action='/forms/submitFormData', role="form")
      .row
        h4 Prefix
        select(name="prefix", required)#prefix
          option Select One
          option Mr.
  