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HOME ADDRESS 7. PRIOR RESIDENCE LIST RESIDENCE FOR FIVE YEARS IF YOU HAVE NOT RESIDED AT THE ABOVE-LISTED HOME ADDRESS FOR THAT PERIOD. FROM TO 8. DATE AND PLACE OF BIRTH U*S* CITIZEN IF NATURALIZED GIVE DATE AND PLACE 9. STATE PRESENT EMPLOYMENT OR OTHER BUSINESS ARE YOU OR HAVE YOU EVER BEEN A LICENSEE 10. ARE YOU OR HAVE YOU EVER BEEN EMPLOYED BY ANOTHER LICENSEE IF YES WHEN AND IN WHAT CAPACITY 11. CONVICTION RECORD The following is a record of all felony and misdemeanor convictions of the ...

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