Registration Form CSLL-446B
1.FULL LEGAL NAME: Pearl Augustine Vivicourt
2. ALL KNOWN ALIASES: Viv, P, Opaline Shimmer (stage name)
3. BIOLOGICAL AGE: 22
4.BIOLOGICAL SEX: Female
5.LONGEVITY (SELECT ONE):
-ALTERED LIFESPAN (+ OR - 50+ YEAR OF NATURALLY EXPECTED LIFESPAN): [__]
-NATURAL LIFESPAN (EXPECTED LIFESPAN FOR SPECIES, BREED AND SEX): [X]
-ALTERED IMMORTALITY (IMMORTALITY GRANTED VIA MAGICAL CHARM, RUNE, ENCHANTMENT OR BLESSING): [__]
-NATURAL IMMORTALITY (IMMORTALITY GRANTED VIA BIRTH, SPECIES, BREED OR SEX): [__]
6. BIRTH DATE (TO THE CLOSEST APPLICABLE YEAR): 03/09/1998
7. BIRTH LOCATION: Sweet Reed, Eriu
8. APPARENT SPECIES:
Teacup Pig
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IF ADDITIONAL SPACE IS REQUIRED, SEE NEXT PAGE.
9. BIOLOGICAL SPECIES:
Teacup Pig
________________________
IF ADDITIONAL SPACE IS REQUIRED, SEE NEXT PAGE.
10. ARE YOU AN ALTERED ENTITY (CHECK ONE): YES [__] NO [X]
IF YES, STATE ANY AND ALL ALTERED ENTITY IDENTIFIERS (INCLUDING BUT NOT LIMITED TO: VAMPIRES, WERE-CREATURES, HALF-BREEDS, SHAPESHIFTERS, LICHES, MUMMIES, DRAUGR, ZOMBIES, UNDEAD) [ooc note: Basically any type of fantasy creature that can be 'created' and not a 'race']:
10A. SELECT ONE (1) IDENTIFIER:
-CIVILIAN (CIV) [X]
-MILITARY (MIL) [__]
-GOVERNMENTAL SERVICES (GSR) [__]
-REGISTERED CRIMINAL (BAD) [__]
IF REGISTERED, LIST ALL APPLICABLE INCARCERATIONS AND DETAINMENT INCLUDING REASON, YEAR & LOCATION:
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IF ADDITIONAL SPACE IS REQUIRED, SEE NEXT PAGE.
-VETERAN MILITARY (VET) [__]
-MILITARY RESERVES (MIR) [__]
NOTE: YOU ARE REQUIRED BY LAW TO SUBMIT A NEW CSLL-446B FORM WITHIN THREE (3) BUSINESS DAYS IF PERSONAL IDENTIFIER CHANGES.
11. ARE YOU A MAGICAL ENTITY (CHECK ONE): YES [__] NO [X]
NOTE: YOU ARE REQUIRED BY LAW TO SUBMIT A NEW CSLL-446B FORM WITHIN THREE (3) BUSINESS DAYS IF MAGICAL STATUS CHANGES.
11A. LIST MAGICAL ABILITIES AND IDENTIFY EACH AS LETHAL OR NON-LETHAL:
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IF ADDITIONAL SPACE IS REQUIRED, SEE NEXT PAGE.
11B: SELECT ONE (1) IDENTIFIER:
- NON-MAGICAL ENTITY (NME) [X]
--NO MAGICAL ABILITY
- MAGICAL-ENTITY-L (ME1) [__]
-- MINOR MAGICAL ABILITY. NON-LETHAL. UNTRAINED OR LIMITED TRAINING
-MAGICAL-ENTITY-M (ME2) [__]
--MODERATE MAGICAL ABILITY. NON-LETHAL. TRAINED.
-MAGICAL-ENTITY-H (ME5) [__]
--HIGH MAGICAL ABILITY. LETHAL OR NON-LETHAL MAGICS. TRAINED OR HIGHLY TRAINED
-MAGICAL-ENTITY-S (ME7) [__]
--HIGH MAGICAL ABILITY. LETHAL OR NON-LETHAL MAGICS. SPECIALLY TRAINED OR MASTER OF MAGICAL SUBJECT
NOTE: YOU ARE REQUIRED BY LAW TO SUBMIT A NEW CSLL-446B FORM WITHIN THREE (3) BUSINESS DAYS IF MAGICAL IDENTIFIER CHANGES.
12. LEGAL RESIDENCE: 100 Casino Corner, Lower Light
13. REGISTERED PROFESSION: Crystal dealer, burlesque performer
13A. PROFESSIONAL ADDRESS: 100 Casino Corner, Lower Light / Boxturn Theater, 910 Wheaton rd, Lower Light
14. LEGAL FAMILY MEMBERS (FUNCTIONALLY LIVING MEMBERS ONLY):
Mother: Petunia Vivicourt
Father: Jed Vivicourt
Brother: French Vivicourt
Brother: Jonas Vivicourt
Brother: Kale Vivicourt
Brother: Don Vivicourt
Brother: Weid Vivcourt
Brother: Lonnie Vivicourt
Brother: Randall Vivicourt
____________________________
IF ADDITIONAL SPACE IS REQUIRED, SEE NEXT PAGE.
NOTE: YOU ARE REQUIRED BY LAW TO SUBMIT A NEW CSLL-446B FORM WITHIN THREE (3) BUSINESS DAYS IF FAMILY DYNAMIC CHANGEs.
15. BLOOD TYPE: O+
16. LEFT THUMB FINGERPRINT: X
17: IDENTIFYING PHOTOGRAPH: X
SIGNATURE AND DATE:
PEARL A. VIVICOURT
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.
1.FULL LEGAL NAME: Pearl Augustine Vivicourt
2. ALL KNOWN ALIASES: Viv, P, Opaline Shimmer (stage name)
3. BIOLOGICAL AGE: 22
4.BIOLOGICAL SEX: Female
5.LONGEVITY (SELECT ONE):
-ALTERED LIFESPAN (+ OR - 50+ YEAR OF NATURALLY EXPECTED LIFESPAN): [__]
-NATURAL LIFESPAN (EXPECTED LIFESPAN FOR SPECIES, BREED AND SEX): [X]
-ALTERED IMMORTALITY (IMMORTALITY GRANTED VIA MAGICAL CHARM, RUNE, ENCHANTMENT OR BLESSING): [__]
-NATURAL IMMORTALITY (IMMORTALITY GRANTED VIA BIRTH, SPECIES, BREED OR SEX): [__]
6. BIRTH DATE (TO THE CLOSEST APPLICABLE YEAR): 03/09/1998
7. BIRTH LOCATION: Sweet Reed, Eriu
8. APPARENT SPECIES:
Teacup Pig
________________________
IF ADDITIONAL SPACE IS REQUIRED, SEE NEXT PAGE.
9. BIOLOGICAL SPECIES:
Teacup Pig
________________________
IF ADDITIONAL SPACE IS REQUIRED, SEE NEXT PAGE.
10. ARE YOU AN ALTERED ENTITY (CHECK ONE): YES [__] NO [X]
IF YES, STATE ANY AND ALL ALTERED ENTITY IDENTIFIERS (INCLUDING BUT NOT LIMITED TO: VAMPIRES, WERE-CREATURES, HALF-BREEDS, SHAPESHIFTERS, LICHES, MUMMIES, DRAUGR, ZOMBIES, UNDEAD) [ooc note: Basically any type of fantasy creature that can be 'created' and not a 'race']:
10A. SELECT ONE (1) IDENTIFIER:
-CIVILIAN (CIV) [X]
-MILITARY (MIL) [__]
-GOVERNMENTAL SERVICES (GSR) [__]
-REGISTERED CRIMINAL (BAD) [__]
IF REGISTERED, LIST ALL APPLICABLE INCARCERATIONS AND DETAINMENT INCLUDING REASON, YEAR & LOCATION:
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
IF ADDITIONAL SPACE IS REQUIRED, SEE NEXT PAGE.
-VETERAN MILITARY (VET) [__]
-MILITARY RESERVES (MIR) [__]
NOTE: YOU ARE REQUIRED BY LAW TO SUBMIT A NEW CSLL-446B FORM WITHIN THREE (3) BUSINESS DAYS IF PERSONAL IDENTIFIER CHANGES.
11. ARE YOU A MAGICAL ENTITY (CHECK ONE): YES [__] NO [X]
NOTE: YOU ARE REQUIRED BY LAW TO SUBMIT A NEW CSLL-446B FORM WITHIN THREE (3) BUSINESS DAYS IF MAGICAL STATUS CHANGES.
11A. LIST MAGICAL ABILITIES AND IDENTIFY EACH AS LETHAL OR NON-LETHAL:
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
____________________________
IF ADDITIONAL SPACE IS REQUIRED, SEE NEXT PAGE.
11B: SELECT ONE (1) IDENTIFIER:
- NON-MAGICAL ENTITY (NME) [X]
--NO MAGICAL ABILITY
- MAGICAL-ENTITY-L (ME1) [__]
-- MINOR MAGICAL ABILITY. NON-LETHAL. UNTRAINED OR LIMITED TRAINING
-MAGICAL-ENTITY-M (ME2) [__]
--MODERATE MAGICAL ABILITY. NON-LETHAL. TRAINED.
-MAGICAL-ENTITY-H (ME5) [__]
--HIGH MAGICAL ABILITY. LETHAL OR NON-LETHAL MAGICS. TRAINED OR HIGHLY TRAINED
-MAGICAL-ENTITY-S (ME7) [__]
--HIGH MAGICAL ABILITY. LETHAL OR NON-LETHAL MAGICS. SPECIALLY TRAINED OR MASTER OF MAGICAL SUBJECT
NOTE: YOU ARE REQUIRED BY LAW TO SUBMIT A NEW CSLL-446B FORM WITHIN THREE (3) BUSINESS DAYS IF MAGICAL IDENTIFIER CHANGES.
12. LEGAL RESIDENCE: 100 Casino Corner, Lower Light
13. REGISTERED PROFESSION: Crystal dealer, burlesque performer
13A. PROFESSIONAL ADDRESS: 100 Casino Corner, Lower Light / Boxturn Theater, 910 Wheaton rd, Lower Light
14. LEGAL FAMILY MEMBERS (FUNCTIONALLY LIVING MEMBERS ONLY):
Mother: Petunia Vivicourt
Father: Jed Vivicourt
Brother: French Vivicourt
Brother: Jonas Vivicourt
Brother: Kale Vivicourt
Brother: Don Vivicourt
Brother: Weid Vivcourt
Brother: Lonnie Vivicourt
Brother: Randall Vivicourt
____________________________
IF ADDITIONAL SPACE IS REQUIRED, SEE NEXT PAGE.
NOTE: YOU ARE REQUIRED BY LAW TO SUBMIT A NEW CSLL-446B FORM WITHIN THREE (3) BUSINESS DAYS IF FAMILY DYNAMIC CHANGEs.
15. BLOOD TYPE: O+
16. LEFT THUMB FINGERPRINT: X
17: IDENTIFYING PHOTOGRAPH: X
SIGNATURE AND DATE:
PEARL A. VIVICOURT
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.
Moderators: Postey