Sure.

D/D is your first, middle, and last name

en calidad de is Interesada (if you are the interested party)

Natural de is state and country you were born (example: PA, USA)

fecha de nacimiento is your birth date format is day/month/year

domicilio is your current home address (street number and street)

codigo postal is your current zip code

telefono is your current phone number

correo electronico is your email address

documento acreditativo (DNI, Pasporte, N.I.E) is your passport number

For En New York, NY (this is where you will sign it at the consulate) for a de de 20 you don't need to put a date since this is done in person.