FORM 1 [See rule 7] Statement as to Place of Ordinary Residence by a Person Holding a Declared Office under Section 164(4) of the Act. Full name_____________________________________________________________ Father's/'Mother's/Husband's name________________________________________ Age ____________________________________Years. Office held ________________________________________________________ I hereby declare that I am a permanent resident of the State and that but for my holding the above-mentioned office, I would have been ordinarily resident at (full postal address) I further declare that my wife (name) _______________________________________ aged___________________________ years. ordinarily resides with me and is a permanent resident of the State. This cancels any previous statement as to place of ordinary residence made by me. Signature __________________________ Place __________________________ Date __________________________ 1. Inserted by SRO-1l2 dated 9-6-1994.
