Registration Form CSLL-446B
1.FULL LEGAL NAME: William Volare Bernadette
2. ALL KNOWN ALIASES: Liam
3. BIOLOGICAL AGE: 32
4. BIOLOGICAL SEX: Male
5. LONGEVITY (SELECT ONE):
-NATURAL IMMORTALITY (IMMORTALITY GRANTED VIA BIRTH, SPECIES, BREED OR SEX): [ X ]
6. BIRTH DATE (TO THE CLOSEST APPLICABLE YEAR): January 11th, 1988
7. BIRTH LOCATION: Great Britain
8. APPARENT SPECIES: Human
9. BIOLOGICAL SPECIES: Human but suspected a bit of fae somewhere up the family tree. Indicative of super fair complexion, eye color, and ears.
IF ADDITIONAL SPACE IS REQUIRED, SEE NEXT PAGE.
10. ARE YOU AN ALTERED ENTITY (CHECK ONE): YES [ X ] NO [__]
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):
10A. SELECT ONE (1) IDENTIFIER:
-CIVILIAN (CIV) [__]
-MILITARY (MIL) [__]
-GOVERNMENTAL SERVICES (GSR) [ X ]
-REGISTERED CRIMINAL (BAD) [__]
IF REGISTERED, LIST ALL APPLICABLE INCARCERATIONS AND DETAINMENT INCLUDING REASON, YEAR & LOCATION: N/A
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: N/A
11B: SELECT ONE (1) IDENTIFIER:
- NON-MAGICAL ENTITY (NME) [ X ]
--NO MAGICAL ABILITY
12. LEGAL RESIDENCE: Inns Boulevard, Lower Light, Eriu
13. REGISTERED PROFESSION: Law Enforcement, Private Class Detective
13A. PROFESSIONAL ADDRESS: [Lower Light PD]
14. LEGAL FAMILY MEMBERS (FUNCTIONALLY LIVING MEMBERS ONLY):
No known blood relatives but additional civil servant documents provided indicate a certain L. Grimm to be their beneficiary in case of incident.
15. BLOOD TYPE: O-
16. LEFT THUMB FINGERPRINT: [Print provided]
17: IDENTIFYING PHOTOGRAPH: [Full uniform picture provided]
SIGNATURE AND DATE:
________William Bernadette___________________ ____________25/01/2020________
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: William Volare Bernadette
2. ALL KNOWN ALIASES: Liam
3. BIOLOGICAL AGE: 32
4. BIOLOGICAL SEX: Male
5. LONGEVITY (SELECT ONE):
-NATURAL IMMORTALITY (IMMORTALITY GRANTED VIA BIRTH, SPECIES, BREED OR SEX): [ X ]
6. BIRTH DATE (TO THE CLOSEST APPLICABLE YEAR): January 11th, 1988
7. BIRTH LOCATION: Great Britain
8. APPARENT SPECIES: Human
9. BIOLOGICAL SPECIES: Human but suspected a bit of fae somewhere up the family tree. Indicative of super fair complexion, eye color, and ears.
IF ADDITIONAL SPACE IS REQUIRED, SEE NEXT PAGE.
10. ARE YOU AN ALTERED ENTITY (CHECK ONE): YES [ X ] NO [__]
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):
10A. SELECT ONE (1) IDENTIFIER:
-CIVILIAN (CIV) [__]
-MILITARY (MIL) [__]
-GOVERNMENTAL SERVICES (GSR) [ X ]
-REGISTERED CRIMINAL (BAD) [__]
IF REGISTERED, LIST ALL APPLICABLE INCARCERATIONS AND DETAINMENT INCLUDING REASON, YEAR & LOCATION: N/A
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: N/A
11B: SELECT ONE (1) IDENTIFIER:
- NON-MAGICAL ENTITY (NME) [ X ]
--NO MAGICAL ABILITY
12. LEGAL RESIDENCE: Inns Boulevard, Lower Light, Eriu
13. REGISTERED PROFESSION: Law Enforcement, Private Class Detective
13A. PROFESSIONAL ADDRESS: [Lower Light PD]
14. LEGAL FAMILY MEMBERS (FUNCTIONALLY LIVING MEMBERS ONLY):
No known blood relatives but additional civil servant documents provided indicate a certain L. Grimm to be their beneficiary in case of incident.
15. BLOOD TYPE: O-
16. LEFT THUMB FINGERPRINT: [Print provided]
17: IDENTIFYING PHOTOGRAPH: [Full uniform picture provided]
SIGNATURE AND DATE:
________William Bernadette___________________ ____________25/01/2020________
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