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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.

Copiah; Hazelhurst-W.S. Henley Building, 122 South Lowe Street; December 13, 1983. 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.

Conference

Greene; Leakesville-FHA 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.

Humphreys; (1) Belzoni-Post Office Building; October 1, 1965; (2) Louise-Post Office Building; June 21, 1966; (3) Isola-trailer 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; Fayette-Ball Drug Store Building, Main Street; November 8, 1965.

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.

Jones; (1) Laurel-Federal Building, Room B-8; August 20, 1965; (2) Ellisville-102 Jasmine Street; September 16, 1967.

Kemper; DeKalb-U.S. Post Office; Lobby; Seventh Street and Eighth Avenue; November 4, 1974.

Leflore; (1) Greenwood-Post Office Building; August 10, 1965; (2) Minter City-trailer on lot on northwest side of Post Office; June 6, 1967.

Lowndes; Columbus-Ramada Inn, Room 153, Highway 45 North; August 22, 1983. Madison; Canton-285 Peace Street; August 10, 1965.

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Monroe; Sheliane Motel, Room 44, Highway 45 N, Aberdeen, Mississippi, 39730; (601) 3692192/2193; September 17, 1991.

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) Building, Front

Brooksville-Jourdan 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.

Scott; Best Western, room 130, Interstate 20 and Highway 251, Forest, Mississippi, 39074; (601) 469-4031 or 3950; May 18, 1993. Sharkey; Rolling Fork-102 Elm Street; June 14, 1967.

Office

Simpson; (1) Mendenhall-Post 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.

Warren; Vicksburg-Post Office and 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.

NEW MEXICO

County; Place for filing; Beginning date. Chavez; Federal Building, 5th and Richardson Street, Roswell, New Mexico; December 17, 1984.

Cibola; U.S. Forest Service, Mt. Taylor Ranger District, Cibola National Forest, 201 Roosevelt, Grants, New Mexico; December 17, 1984.

Curry; Main Post Office, 417 Gidding, Room 203, Clovis, New Mexico; December 17, 1984.

McKinley; Bureau of Indian Affairs, Eastern Navajo Agency, P.O. Box 328, Crowpoint, New Mexico (25 miles north of Thoreau, 1 mile west of State Road 57); Bureau of Indian Affairs, Navajo Area Office, Federal Building, 3rd and Hill Streets, Gallup, New Mexico; December 17, 1984.

Otero; U.S. Forest Service, Lincoln National Forest, Federal Building, 11th and New York Streets, Alamogordo, New Mexico; December 17, 1984.

Sandoval; Mobile unit on parking lot behind U.S. Post Office, Camino del Pueblo Road, Bernalillo, New Mexico; U.S. Forest Service, Cuba Ranger District, San Fe National Forest, State Highway 126 and South Main, Cuba, New Mexico. December 17, 1984.

NEW YORK

County; Place for filing; Beginning date Bronx, Kings, and New York Counties, New York; 26 Federal Plaza, Room 29108, New York, New York.

NORTH CAROLINA

County; Place for filing; Beginning date Edgecombe; Tarboro-Room B3, U.S. Post Office, 525 Main Street, Tarboro, North Carolina; May 4, 1984.

SOUTH CAROLINA

County; Place for filing; Beginning date

Bamberg; Room 6, Farmers Home Administration, J. Carl Kershe Agriculture Building, Calhoun Street, Bamberg, South Carolina. October 10, 1984.

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Colleton; Soil Conservation Service, Room 203, 119 Benson Street, Walterboro, South Carolina. October 10, 1984.

Darlington; Darlington-U.S. Post Office, 201 Pearl Street; November 7, 1978.

Dorchester; St. George-U.S. Post Office; November 8, 1965.

Hampton; Farmers Home Administration, 1st Floor, 1003 Elm Street, Hampton, South Carolina. October 10, 1984.

Marion; Marion-U.S. Post Office, 201 South Main Street, Conference Room; June 27, 1978.

Richland; Room 1466, Strom Thurmond FOB, 1835 Assembly Street, Columbia, South Carolina. September 28, 1984.

Williamsburg; ASCS Service Center, 208 Short Street, Kingstree, South Carolina. September 28, 1984.

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.

Dallas; Dallas OPM, Room 6B3, 1100 Commerce Street, Dallas, Texas, April 4, 1984.

El Paso; El Paso-2211 East Missouri Avenue, Suite N300; November 7, 1978.

Fort Bend; Richmond-Agricultural Stabilization Conservation Office; May 1, 1976. Frio; Pearsall-Federal Building, 411 East Colorado Avenue; November 2, 1976.

Hidalgo-101 East 14th (West Entrance), Mission, Texas, 78572, (512) 585-8380, November 8, 1988.

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

Medina; Hondo-Agricultural Stabilization Conservation Office; 1703 Avenue K; May 1,

1976.

Reeves; Pecos-U.S. Post Office, U.S. Attorneys Office, Room 301; May 6, 1978.

Uvalde; Uvalde-Agricultural Stabilization Conservation Office; 119 West South Street; May 1, 1976. Wilson;

Floresville Agricultural Stabilization Conservation Office; May 1, 1976.

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

8. (a) Are you now registered to vote in Alabama? O Yes No

(b) Are you now listed under the Voting Rights Act? Yes No

9. Are you a citizen of the United States and of the State of Alabama? Yes O

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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

* August 1965

Back

Do not write on this side-for use by examiner

ADDITIONAL INFORMATION ITEMS

2. If applicant shows his age to be under 21, write in his date of birth

4. If applicant shows that he has not lived in Alabama for one year, will he have lived in Alabama for one year by the date of the next election? Yes No

If yes, write in the date residence began

Former Address

5. If applicant shows that he has not lived at his present address for six months, will he by the date of the next election have:

Lived in the same county for six months? O Yes No

If yes, write in the date residence began

Former Address

Lived in his precinct or ward for three months? Yes No

If yes, write in the date residence began

Former Address

Lived in the same city or town for three months? Yes No

If yes, write in the date residence began

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

If yes, write in his occupation

8. (a) If applicant shows that he is now registered to vote in Alabama, 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 Was the con

convicted?

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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 I am not registered to vote under any other name; that I have correctly answered the questions appearing elsewhere on this application; that the information contained elsewhere on this application is true.

Signature (or mark) of applicant

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

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

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(First) (Last)

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Do not write on this side-for use by the Examiner

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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

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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 I will faithfully and fully abide by all of the laws of the State of Louisiana, that I am well disposed to the good order and happiness of the State of Louisiana and of the United States, and that the information I have provided is true to the best of my knowledge and belief. Signature (or mark) of applicant

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

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

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Lived in the same town or city for four months? Yes No

If yes, write in the date residence began

Former Address

7. If applicant's answer is yes, is his residence in Louisiana and in his parish for temporary purposes only?

☐ 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? Yes No

If a disqualifying crime, has applicant been pardoned with express restoration of the right to vote? Yes No

If so pardoned, how and when?

11. If applicant answers yes, write in whether dishonorably discharged or a deserter?

If dishonorably discharged, has he been reinstated? -OYes O No

If yes, when and where?

If a deserter, has he returned to his command and made up his lost time? ·

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If yes, when and where?

12. If applicant shows that he has been declared legally insane or incompetent by a court, has he subsequently been declared legally sane or competent by a court?

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If yes, when and what court?

13. If the applicant shows that he is now living in a charitable home or institution, is he disqualified? Yes No

Certificate of Eligibility Issued-No.
Notice of Ineligibility Issued-No.

MISSISSIPPI

Front

Form approved

Budget Bureau No. 50-RO436

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