Personal History Statement (Phs) Page 6
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24Akron Police Division
Personal History Statement (PHS)
Residence
17. Please list all of your residences going back at least 20 years. There should be no gaps in residence dates. Begin with your current
residence and list backward in chronological order.
Dates
If rented, give name, address and telephone of the
Address
City, State, Zip Code
From
To
Person responsible for the collection of the rent
Mo / Yr
Mo/Yr
Current
A
With whom do you live? (include relationship)
B
With whom did you live? (include relationship)
Reason for moving
C
With whom did you live? (include relationship)
Reason for moving
D
With whom did you live? (include relationship)
Reason for moving
E
With whom did you live? (include relationship)
Reason for moving
F
With whom did you live? (include relationship)
Reason for moving
G
With whom did you live? (include relationship)
Reason for moving
H
With whom did you live? (include relationship)
Reason for moving
I
With whom did you live? (include relationship)
Reason for moving
Page 6 of 24
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