Volume 799, Page 1923 View pdf image |
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ROBERT L. EHRLICH, JR., Governor Ch. 207 ____ASSIGNMENT OF A PARENT OR LEGAL GUARDIAN OF A CHILD TO ACTIVE MILITARY DUTY (III) THE NAME AND LAST KNOWN ADDRESS OF THE CHILD'S (IV) MY KINSHIP RELATION TO THE CHILD IS____________ (V) MY ADDRESS IS: STREET APT. NO. CITY STATE ZIP CODE (VI) I ASSUMED INFORMAL KINSHIP CARE OF THIS CHILD FOR 24 (VII) THE NAME AND ADDRESS OF THE LAST SCHOOL THAT THE (VIII) THE COUNTY SUPERINTENDENT MAY VERIFY THE FACTS (IX) I SOLEMNLY AFFIRM UNDER THE PENALTIES OF PERJURY SIGNATURE OF AFFIANT (DAY/MONTH/YEAR) (X) ANY PERSON WHO WILLFULLY MAKES A MATERIAL - 1923 -
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Volume 799, Page 1923 View pdf image |
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