This should be selected from a residence certificate. I tried to translate it here.
I certify that the following is a true and correct copy of the registered information for the residence under:
Residence number:130281459005920 Name of the person in charge for residents:Youshun SHI
Address: No.2, Building 11, Jinxin North Road, Shigezhuang Village, Malanyu Town, Zunhua City, Hebei Province.
The registered items for one person under said residence number are listed below: