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23. In what State or Territory have you
legal or voting residence?  
New York

Length of such residence therein?
(Residence must be shown up to date of jurat)
From May, 11908, to July, 1938
(Month) (Year) (Month) (Year)

In what county have you legal or
voting residence?
[[Rt?]]

Length of such residence in county?
(Residence must be shown up to date of jurat)
From May, 1908, to Feb, 1938
(Month) (Year) (Month) (Year)

24. If during the past year you have not resided continuously in the State or Territory in which you claim legal or voting residence, or are not now actually living in such State or Territory, answer the following questions fully:

(a) For what periods since such residence was first established have you been absent therefrom? (Give dates) July 1938 to Date
(b) What is the name, address, and relationship of the person, if any, with whom you make your home at the present time in
the State or Territory in which you claim legal or voting residence?
Mother
(c) Are you now a voter in such State or Territory?
(Answer "Yes" or "No")
Yes

25. If you are under 21 years of age, give the legal residence and the post-office address of your parent or parents, or your guardian.

Legal residence of parents or guardian
State
County

Length of such residence
From, 1, to, 19
(Month) (Year) (Month) (Year)

Present post-office address
City or town
County                State

26. If you are a married woman fill in the following blanks:
(a) Legal residence of husband:
(b) Duration of his residence therein: From: (month), 1 (year), to (month)

The composition and work in connection with any material required to be submitted for this examination are entirely my own, except where I have given full credit for quoted matter or the collaboration of others by quotation marks and references, and in the composition of the same I have received no assistance [[underlined]] except [[/underlined]] as indicated fully in my explanatory statement.

I, the undersigned, DO SOLEMNLY SWEAR (OR AFFIRM) that the statements made by me in answer to the foregoing questions are [[underlined]] full [[/underlined]] and [[underlined]] true [[/underlined]] to the best of my knowledge and belief. SO HELP ME GOD.

[[boxed] 
If female, prefix "Miss" or Mrs." and if married, use your own given name, as "Mrs. Mary L. Doe."

(Signature of applicant) (Sign your name in full- one given name, additional initials, if any, and surname in full)

JURAT OR OATH.- This jurat or oath must be executed.
The following oath must be taken before a NOTARY PUBLIC, or other officer authorized to administer oaths, [[underlined]] before whom the applicant must appear in person.[[end underline]] The following are those not authorized to administer this oath: Postmasters, Army officers, post-office inspectors, and chief clerks and assistant chief clerks in the Railway Mail Service.
Subscribed and duly sworn to before me according to law by the above-named applicant, this ______ day of _________, 19_____, at city [or town] of ________, county of _______, and State [or Territory or District] of _________

(Signature of officer)
(official title)

OFFICER'S CERTIFICATE OF RESIDENCE
Except as specified below, this certificate is required of all applicants for positions in the apportioned Departmental Service at Washington, D.C., INCLUDING RESIDENTS OF THE DISTRICT OF COLUMBIA. Eligibility for the apportioned service will not be allowed unless legal requirements are met and this certificate is properly executed. 
This certificate must be executed by a notary public, county, municipal, or police-court clerk, mayor, justice of the peace, or other officer in the county or city in which the applicant claims residence, provided the officer has an official (impression) seal, or, in lieu thereof, that his official character is certified to by proper officer, under official (impression) seal, and provided he is an actual resident and officer in the same county in the same county or city acclaimed by the applicant.
Applicants who occupy permanent positions in the apportioned Departmental Service at Washington are not required to have this certificate executed, but should make the following notation opposite it: "Am in the apportioned Departmental Service."
The applicant is not required to appear in person before the officer who executes this certificate, but the officer  should satisfy himself as to facts which he certifies, from credible and competent evidence.

I, a (official designation of officer) of the county of __________, and State [or Territory] of __________ do hereby certify that (Write name to agree exactly with applicant's name as given above),the applicant who submits the above in connection with a civil service examination, is now a resident of the county of ________, and State [or Territory] of _______, and has been such resident for _____ years _____ months next preceding the date hereof.
Dated at ______, county of _______, and State [or Territory]  of _______, this ______ day of ______, 19___

[OFFICIAL IMPRESSION SEAL]

(Signature of officer)

[?] The official seal must not be omitted. Any addition to or alteration in the printed wording will nullify the certificate. If erasure or correction be made in "Officer's Certificate", certificate must be made on margin by the officer who executes the  certificate, showing such correction.

U.S. GOVERNMENT PRINTING OFFICE-O 16-524
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