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CITY OF ST. ANTHONY <br /> • 3301 Silver Lake Road <br /> Minneapolis, Minnesota I <br /> Directions: Please complete in duplicate with typewriter or by printing in ink. <br /> Date: 2/25/83 <br /> 1. True Name: (Last, First, Middle) <br /> FERRIL, WILLIAM C. <br /> 2. Residence Address: (Number, Street, City, State) 3. Phone Number: <br /> 2645 Garland Lane Plymiouht, "MN 473-0527 <br /> 4. Business Address: (Number, Street, City, State S. Phone Number: <br /> 4640 W. 77th ,St'.. = Suite. 196 Mpls. , MN, 835-7137 <br /> 6. Place of Birth: (County, City, State) 7. Date of Birth: (bb. Day/Yr.) <br /> Buchanan St. Joseph,,. Missouri' 6-5-31 <br /> 8. U. S. Citizen? . Yes k Naturalized? . Yes 11, ...Yes, give date and place... <br /> No No <br /> • 9. Tf you have ever used or been known by a name or names other than the true name <br /> given in 01 above, list such name(s) and information concerning dates and places <br /> where used: ' <br /> Names Dates , Places, and Circumstances <br /> 10. Marital Status: Single Iridolied Separated <br /> Married x Divorced <br /> 11: It-Married, true name, place and date of birth, and residence adJress or spouse: <br /> True, Name: ElPannr T.. Ferril <br /> Place and Date of Sirth: Brookfield, Missouri 10110/35 <br /> Residence Address: Garland Lane - Plymouth, MN <br />