I affirm that I currently reside at the address listed above and have been a continuous resident of the state of Pennsylvania for the past ten (10) years. I am not disqualified from service as a volunteer pursuant to 23PaC.S.§6344 © and have not been convicted of an offense similar in nature to those crimes listed in 23 PA.C.S §6344 © under the laws of the United States or one of its territories, possessions, another State, the District of Columbia, the Commonwealth of Puerto Rico or a foreign nation, or under a former law of this Commonwealth.

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