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I f none describe location of residence. Do not include P. O. Box or Rural Rt. MAILING ADDRESS If different from residence address CITY STATE EMAIL ADDRESS Optional ZIP X OCCUPATION Do not leave blank DATE OF BIRTH pc t -Ti C - S TELEPHONE NUMBER Include area code Optional OFFICE HOME SiZ. - f VOTER REGISTRATION VUID NUMBER if applicable f /ll Length of Continuous Residence as of Date Applicatioil Sworn - Blp t 3 L yr s j J mos IN CITY yr s mos IN DISTRICT OR PRECINCT 5 yr s If using a...

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