East Carroll; (1) Lake Providence-Post Office Building; August 10, 1965; (2) Sondheimer-trailer at Post Office Building; February 14, 1966; (3) Lake Providence-ASCS Office, 205 North Hood; October 19, 1979.

East Feliciana; (1) Clinton-Kline Building, St. Helena Street; August 10, 1965, to February 8, 1966; (2) Clinton-Trailer at U.S. Post Office; February 19, 1966; (3) Jackson-Trailer parked on Post Office grounds; February 14, 1966; (4) SlaughterPost Office Building; February 14, 1966.

Madison; Tallulah-Post Office; August 13, 1966.

Ouachita; (1) Monroe-Post Office Building, Room 301; August 20, 1965; (2) West Monroe-I. B. Haynes Building, Cypress and Young Streets, February 14, 1966. Plaquemines; (1) Buras-Post Office Building, August 10, 1965, through November 17, 1965, reopened August 31, 1967; (2) Belle Chasse-Post Office Building; November 18, 1965; (3) Belle Chasse-US Naval Air Station, Administration Building, Room 46, Office of the Senior Chief of Command; October 19, 1979.

Sabine; Many-U.S. Post Office Building; 525 San Antonia Avenue; September 27, 1974.

St. Helena; Greensburg-(1) Trailer at Post Office; College and Main Streets; August 19, 1972; (2) ASCS Office, Burrell Carter Building, Street Floor, South Main Street; October 19, 1979.

St. Landry; Opelousas-Chattau Motor Inn, 400 East Landry, the Bayou Room; December 5, 1979.

West Feliciana; (1) Saint Francisvilletrailer at Post Office; November 3, 1965, through January 7, 1966; (2) Saint Francisville-Post Office Building; January 8, 1966; (3) Weyanoke-trailer located on State Highway 66 approximately 0.3 mile South of Weyanoke; February 14, 1966.

MISSISSIPPI

County; Place for filing; Beginning date Amite; (1) Liberty-Walsh Building, Main Street, second floor; April 3, 1967; (2) Gloster-Ivey Building, First Street; July 29, 1967.

Benton; Ashland-Post Office Building; October 1, 1965.

Bolivar; Cleveland-Post Office Building; October 1, 1965.

Carroll; (1) Carrollton-Post Office Building, Main Street, January 4, 1966, through March 22, 1968; (2) North Carollton-Van Meter Lumber Co. Building, George Street, March 23, 1968.

Claiborne; (1) Port Gibson-McFatters Drug Store, Second Floor, 618 Main Street; April 16, 1966, through October 9, 1969; (2) Port Gibson-Federal Building, Room 111; October 10, 1969.

Clay; (1) West Point-Post Office Building; October 1, 1965; (2) Pheba-rear of Champion Grocery Store; July 21, 1967.

Coahoma; Clarksdale-Post Office Building; October 1, 1965.

Covington; Collins-McLauren Building, FHA Conference Room; August 10, 1979.

De Soto; (1) Walls-U.S. Post Office; November 8, 1965, through January 4, 1966; (2) Hernando-U.S. Post Office; January 5, 1966; (3) Olive Branch-second floor above Post Office; July 22, 1967.

Forrest: (1) Hattiesburg-U.S. Courthouse, corner of Pine and Forrest Streets, Room 6; June 8, 1967; (2) Petal-108 Ninth Avenue; September 16, 1967.

Franklin; Meadville-Old Halford Building, Highway 84 East, one block from city square; April 3, 1967.

Greene; Leakesville-FHA Conference Room, New Bank Annex, Main and Lafayette Street; August 10, 1979.

Grenada; (1) Grenada-Post Office Building; July 22, 1966, through August 7, 1966; (2) Grenada-639 Union Street; August 8, 1966, through October 9, 1969; (3) Grenada-U.S. Post Office, basement, October 10, 1969; (4) Tie Plant-trailer at site of Horseshoe Store two blocks west of Tie Plant School on dirt road; September 9, 1966.

Hinds; (1) Jackson-301 Building, 301 North Lamar Street; November 8, 1965, through January 2, 1966; (2) Jackson-Post Office Building, 245 East Capitol Street; January 3, 1966; (3) Jackson-848 Lynch Street; June 22, 1966; (4) Raymond-U.S. Post Office; November 8, 1965.

Holmes; (1) Lexington-U.S. Post Office; November 8, 1965; (2) Cruger-U.S. Post Office; July 29, 1967.

Office

Humphreys; (1) Belzoni-Post Building; October 1, 1965; (2) Louise-Post Office Building; June 21, 1966; (3) Isolatrailer at Post Office, August 23, 1971.

Issaquena; Mayersville-trailer at Post Office; June 15, 1967.

Jasper; Bay Springs-trailer at New Post Office; April 16, 1966.

Jefferson Davis; (1) Prentiss-Magnolia Courts, intersection of U.S. Highway 84 and State Highway 42, Units 21 through 24; August 25, 1965, through August 26, 1965; (2) Prentiss-Post Office Building; August 27, 1965.

Neshoba; Philadelphia--U.S. Post Office; November 8, 1965.

Newton; (1) Newton-Post Office Building; January 4, 1966; (2) Decatur-building on Fourth Avenue across street from U.S. Post Office; July 29, 1967.

Noxubee; (1) Macon-Post Office Building, Basement, Room 1; April 16, 1966; (2) Brooksville-Jourdan Building, Front Street; July 29, 1967.

Oktibbeha; Starkville-Post Office Building, 302 University Drive; April 3, 1967.

Pearl River; Picayune-Community Recreation Center; Library; Rosa and Beech Streets; June 8, 1974.

Quitman; Marks-Corp of Engineers, Rogers Road; October 29, 1980.

Rankin; (1) Brandon--Rankin Building, intersection of U.S. Highway 80 and State Highway 18; April 16, 1966, through August 4, 1966; (2) Brandon-Nettles Drug Store Building, East Government Street; August 5, 1966 through January 31, 1971; (3) Brandon-280 Government Street; February 1, 1971.

Sharkey; Rolling Fork-102 Elm Street; June 14, 1967.

Simpson (1) Mendenhall-Post Office Building; January 4, 1966; (2) Magee-Post Office Building, Ninth Avenue (between Eighth and Ninth Streets); January 10, 1966.

Sunflower; (1) Indianola-Post Office Building; May 2, 1967; (2) Ruleville-U.S. Post Office, 120 South Ruby Avenue; June 16, 1983.

Tallahatchie; (1) Charleston-103 Market Street; August 23, 1971; (2) Sumner--Abbey Building, East Court Square; August 23, 1971.

Tunica; Tunica-Department of Agriculture Building, Agricultural Conservation and Stabilization Service; South Side, Court Square; November 3, 1975.

Office

and

Warren; Vicksburg-Post Courthouse Building, Crawford and Monroe Streets; January 4, 1966.

Washington; Greenville-Room 204A Federal Building, Main Street and Poplar Street; August 8, 1983.

Wilkinson; (1) Woodville-Post Office Building; August 8, 1967, to August 24, 1967; (2) Woodville-Odd Fellows Building; August 24, 1967.

Winston; Louisville-Post Office Building; Basement, Room 6; April 16, 1966.

Yazoo; Yazoo City, 100 South Main Street; November 2, 1971.

TEXAS

County; Place for filing; Beginning date Atascosa; Pleasanton-Office of USDA, 803 North Bryant; October 29, 1980

Bee; Beeville-Agriculture Plant and Animal inspection Service; Basement, U.S. Post Office, 111 N. St. Mary's Street; November 2, 1976.

Crockett; Ozona-Agricultural Stabilization and Conservation Office, 801 Avenue E; August 12, 1978.

El Paso; El Paso-2211 East Missouri Avenue, Suite N300; November 7, 1978. Fort Bend; Richmond-Agricuitural Stabilization Conservation Office; May 1, 1976. Frio; Pearsall-Federal Building, 411 East Colorado Avenue; November 2, 1976.

La Salle; Cotulla-U.S. Border Patrol Station, Federal Building. North Main Street; November 2, 1976.

11. Have you ever been declared legally insane by a court? Yes No

Any willful false statement on this application is a Federal crime punishable by fine or imprisonment.

STOP HERE. TAKE THE FORM TO THE
EXAMINER

I do solemnly swear (or affirm) that the information I have provided is true and correct to the best of my knowledge, information, and belief. I do further personally swear (or affirm) that I will support and defend the Constitution of the United States and the Constitution of the State of Alabama; and that I do not believe in nor am I affiliated with any group or party which advocated or advocates the overthrow of the Government of the United States or of the State of Alabama by unlawful means. Signature (or mark) of Applicant

Sworn to (or affirmed) and subscribed before me on this date

Examiner

U.S. Office of Personnel Management CSC Form 805-A

† August 1965

Certificate of

Back

No.

months by the date of the next election? Yes No

If yes, write in the date residence began

Former address

7. If applicant answers yes, is his residence in Georgia and in his county for temporary purposes only? Yes No

8. (a) If applicant shows that he is now registered to vote in Georgia, write in the county where he is registered

(b) If applicant shows that he is now listed under the Voting Rights Act, write in the county where he is listed and certificate number if available

10. If applicant answers yes, name the crime Where and when convicted? Was the con

viction for a disqualifying crime? Yes No

If a disqualifying crime, has applicant been pardoned? Yes No

If so pardoned, where and when?

11. If applicant answers yes, has he subsequently been declared legally sane or competent by a court? OYes O No

If yes, when and by what court?
Certificate of Eligibility Issued-No.
Notice of Ineligibility Issued-No.

Do not write on this side-for use by the

Examiner

or Town)

4. How long have you lived in Louisiana? –

5. How long have you lived at the above address?

6. What is your precinct and ward?

7. Are you now (1) on active duty in the Armed Forces of the United States or the Louisiana National Guard, (2) an employee of the United States or the State of Louisiana, or (3) a seaman or college student? OYes O No

8. (a) Are you now registered to vote in Louisiana? O Yes No (b) Are you now listed under the Voting Rights Act? Yes No

If yes, write in his occupation

8. (a) If applicant shows that he is now registered to vote in Louisiana, write in the parish where he is registered:

(b) If applicant shows that he is now listed under the Voting Rights Act, write in the parish where he is listed

and certificate number if available

10. If applicant answers yes, name the crime

Where and when convicted?

Was the conviction for a disqualifying crime? O Yes No

If a disqualifying crime, has applicant been pardoned with express restoration of the right to vote? -O Yes No If so pardoned, how and when?