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Complete the LAST, OTHER CHANGES, FIRST NAME, MIDDLE NAME, EYE COLOR (Please check one):, BLUE, BROWN, GREEN, HAZEL, PINK, BLACK, GRAY, DICHROMATIC, OTHER _________________, CORRECTION OF DATE OF BIRTH, HEIGHT, SOCIAL SECURITY NUMBER, DROP PRIVILEGE:, SEX, HTNOM, DAY, RAEY, FEET, INCHES, Drop Class M, MALE, FEMALE, D CONSENT OF PARENT, Applicant is less than 18 years of, I hereby certify that I am a, Parent, Guardian, Person in Loco Parentis, Spouse at least 18 years of age, Do give consent, Do not give consent for, XSIGN, HERE, E B, T S U M L L A, F I, D E R E W S N A, T N E M E C A L P E R, D E T S E U Q E R, No person may hold more than one, and (SIGNATURE OF PARENT fields with any content that may be requested by the system.
Within the segment referring to T S U M L L A, D E R E W S N A, T N E M E C A L P E R, D E T S E U Q E R, suspension or revocation of your, If yes, law that all, AUTHORIZATION AND CERTIFICATION I, I wish to contribute $1, FEE PAID, Send Check, In This, Amount, AFFIDAVIT: This section must be, SUBSCRIBED AND SWORN, TO BEFORE ME:, DAY, YEAR, Signature of Person Administering, XSIGN, HERE, (APPLICANT'S SIGNATURE IN INK), SEE REVERSE FOR FEES, WARNING: Misstatement of fact is a, S E A L, and SIGN IN PRESENCE OF NOTARY, you have to jot down some significant particulars.
It is essential to indicate the rights and responsibilities of each side in part During the next 60 days I will be, I hereby request an exemption from, Military, School, Work, Travel, Within 45 days of my return I will, NAME OF RELIGIOUS GROUP, My religious beliefs forbid the, • Religious Exemptions:, If requesting a religious, SIGNATURE HERE, SIGNATURE HERE, • Out-of-State Address Change : We, I certify that my workplace is, US Armed Forces, Federal Government, Relationship to person meeting, Pennsylvania State Government, and • Return your completed and signed.
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