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PERSONAL INFORMATION <br />Page 2 <br /> <br />Are you a registered voter? <br /> <br />Yes: <br />No: <br /> <br />Is your spouse a registered voter: Yes: <br /> No: <br /> <br />If yes, where are you registered: <br /> <br />If yes, where: <br /> <br />Address(es) at which you have lived during preceding five years: <br />address and work back.) <br /> <br />(Begin with present or last <br /> <br />Street Address <br /> <br />City/State/Zip Dates <br /> <br />Address(es) at which your present spouse has lived during preceding five years: <br />present or last address and work back.) <br /> <br />(Begin with <br /> <br />Kind, name and location of every business or occupation you have been engaged in during <br />preceding five years: (Begin with present or last occupation and work back.) <br /> <br />Business or Occupation <br /> <br />Street Address <br /> <br />City/State/Zip <br /> <br />Dates <br /> <br />Kind, name and location of every business or occupation you have been engaged in during <br />preceding five years: (Begin with present or last occupation and work back.) <br /> <br /> <br />