I, the undersigned, do swear or affirm under penalty of perjury that I have been a citizen resident of this State as required by NRS 218A.200; that I understand that knowingly and willfully filing a declaration of residency which contains a false statement is a crime punishable as a gross misdemeanor and also subjects me to a civil action disqualifying me from entering upon the duties of the office; and that I have actually, as opposed to constructively, resided at the following residence or residences since November 1 of the preceding year:
............................................................... | |
Street Address | Street Address |
............................................................... | |
City or Town | City or Town |
............................................................... | |
State | State |
From....................... To.................... | From....................... To.................... |
Dates of Residency | Dates of Residency |
............................................................... | |
Street Address | Street Address |
............................................................... | |
City or Town | City or Town |
............................................................... | |
State | State |
From....................... To.................... | From....................... To.................... |
Dates of Residency | Dates of Residency |
(Attach additional sheet or sheets of residences as necessary)
NRS 293.181