Fillable form display error

While filling out a form provided by our state government, we noticed it does not display the data correctly.  The form has been filled out using both Acrobat Pro and Reader, no difference in the result.  Printing the document does not correct the error, and other PDF viewers also show the same error.  This is a protected document, so I can't make changes to the document.  Both Acrobat Pro and Reader have the latest updates installed.  I have attached a screenshot of the issue.  Is anyone familiar with this issue?