Application For Classification As A Legal Resident - Wayne Community College Page 2
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312.
Give names of each state where you did each of the following during the last 24 months and the month, day, and year for each time you did
each such act (or if not done in the last 24 months, where and when such acts were done last; if never done at all, write “never”).
(State[s])
(Month / Day / Year)
a)
Voted ___________________________________________________________
__________________
________________________
b)
Registered to vote _________________________________________________
__________________
________________________
c)
Called to serve on jury duty __________________________________________
__________________
________________________
d)
Acquired or renewed driver’s license ___________________________________
__________________
________________________
e)
Filed state income tax return _________________________________________
__________________
________________________
f)
Filed state intangible tax return _______________________________________
__________________
________________________
g)
Listed personal property for taxation ___________________________________
__________________
________________________
h)
Acquired ownership of property for use as
your principal dwelling ______________________________________________
__________________
________________________
i)
Registered/licensed a motor vehicle (car, truck, or other requiring license)
Type of vehicle (list all)
Where registered/licensed
(Month / Day / Year)
_______________________________
________________________________________________
________________________
_______________________________
________________________________________________
________________________
13.
The car(s) or other motor vehicles which you maintain and operate in N. C. are owned by (name) ______________________________________
_________________ (address)___________________________________________________________________________________________
Registered/licensed in (state or foreign country) ______________________________________________________________________________
Insured in the name of ________________________________________________ (address) _________________________________________
____________________________________________________________________________________________________________________
14.
List the addresses at which you own and maintain personal property (clothing, furniture, cars, boats, checking or savings accounts, stocks,
bonds, dogs, jewelry, appliances, etc.) and give percentage value (of total personal property) maintained at each address:
% at this
Address
Address
a) _______________________________________________________________________________________
________________________
b) _______________________________________________________________________________________
________________________
15.
List your employment for wages in the last 24 months:
Dates
Hrs. per
Job Title
Employer
Address (city & state)
(from)
(to)
week
a) ___________________
________________________
______________________________
_______
_______
_______________
b) ___________________
________________________
______________________________
_______
_______
_______________
c) ___________________
________________________
______________________________
_______
_______
_______________
If married, list your spouse’s employment for wages in the last 24 months:
Dates
Hrs. per
Job Title
Employer
Address (city & state)
(from)
(to)
week
a) ___________________
________________________
______________________________
_______
_______
_______________
b)___________________
________________________
______________________________
_______
_______
_______________
c) ___________________
________________________
______________________________
_______
_______
_______________
16.
List the sources and uses of the money required to meet your expenses: (Do not give dollar amounts.)
Preceding Calendar Year (Jan.-Dec. 20___)
Current Calendar Year (Jan.-Dec. 20___)
Source
% of Total
Used for
% of Total
Used for
Your earnings
_______________
______________________________
________________
______________________________
Parent(s) or Guardian _______________
______________________________
________________
______________________________
Spouse’s earnings
_______________
______________________________
________________
______________________________
Other (specify)
_______________
______________________________
________________
______________________________
100%
100%
17.
Are you now in, or a veteran of, active military service or other Federal government employment?
Yes
No. If answer is “yes,” give your
home address upon entry _______________________________________________________________________________________________
Your offi cial home address now __________________________________ Date this home address was declared _________________________
Your offi cial “home of record” ____________________________________________________________________________________________
Legal residence you most recently claimed on DD Form 2058 (State of Legal Residence Certifi cate) ___________________________________
Date you completed DD Form 2058 (State of Legal Residence Certifi cate) ________________________________________________________
Your home address upon discharge ____________________________________ Date of discharge __________________________________
Place to which you were paid mileage upon discharge _______________________________________________________________________
18.
If you (1) now live regularly with, (2) have lived with during the immediately preceding 24 months, or (3) continue to maintain close ties with and
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Parent category: Business