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Registration Form CSLL-446B

1.FULL LEGAL NAME: Richard Grey

2. ALL KNOWN ALIASES:

3. BIOLOGICAL AGE: 42

4.BIOLOGICAL SEX: Male

5.LONGEVITY:

-ALTERED LIFESPAN (+ OR - 50+ YEAR OF NATURALLY EXPECTED LIFESPAN): [X]

6. BIRTH DATE: April 17, 1978

7. BIRTH LOCATION: Espallia

8. APPARENT SPECIES:
Human

9. BIOLOGICAL SPECIES:
Human

10. ARE YOU AN ALTERED ENTITY (CHECK ONE): YES [__] NO [X]

10A. SELECT ONE (1) IDENTIFIER:

-REGISTERED CRIMINAL (BAD) [X]
IF REGISTERED, LIST ALL APPLICABLE INCARCERATIONS AND DETAINMENT INCLUDING REASON, YEAR & LOCATION:
"Insert very extensive list here"
IF ADDITIONAL SPACE IS REQUIRED, SEE NEXT PAGE. (There's probably several pages)

11. ARE YOU A MAGICAL ENTITY (CHECK ONE): YES [__] NO [X]

11B: SELECT ONE (1) IDENTIFIER:

- NON-MAGICAL ENTITY (NME) [X]
--NO MAGICAL ABILITY


12. LEGAL RESIDENCE: Wild Hunt Manor, Lower Light, Eriu

13. REGISTERED PROFESSION: Unknown

13A. PROFESSIONAL ADDRESS: N/A

14. LEGAL FAMILY MEMBERS (FUNCTIONALLY LIVING MEMBERS ONLY):
______None Listed_______


15. BLOOD TYPE: Unclassified

16. LEFT THUMB FINGERPRINT: -insert print here-

17: IDENTIFYING PHOTOGRAPH: -insert photo here-

SIGNATURE AND DATE:

Richard Grey - Dec 31,2019

BY SIGNING THIS DOCUMENT I (THE APPLICANT OF THIS DOCUMENT AND/OR THEIR GUARDIANS) HEREBY ACKNOWLEDGE THAT ANY AND ALL INFORMATION SUBMITTED ON DOCUMENT CSLL-446B IS COMPLETE AND TRUTHFUL TO THE BEST OF MY ABILITY. ANY FALSIFYING OF INFORMATION OR DOCUMENTS WILL BE PERSECUTED TO THE FULLEST EXTENT OF THE LAW. BY SIGNING THIS DOCUMENT I (THE APPLICANT OF THIS DOCUMENT AND/OR THEIR GUARDIANS) HEREBY AGREE TO BE ADDED TO THE CITY OF LOWER LIGHT'S GOVERNMENTAL CENSUS AND AGREE THAT ANY FALSIFIED INFORMATION OR DOCUMENTS WILL TERMINATE YOUR CITIZENSHIP OR APPLICATION OF CITIZENSHIP OF LOWER LIGHT AND WILL RESULT IN IMMEDIATE DEPORTATION.

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