SURNAME: Bowers
FIRST NAME: Charles
ADDRESS OF RESIDENCE: 1 Montagne Lane
DATE OF BIRTH: 25th of Sun’s Smile 1699
Are you registered and eligible to vote in the province of Curon?: Yes
Do you have any other title, peerage or public service that may conflict with becoming an Imperial Senator, as per the Edict of Establishment (1736) or Edict of Election (1736)?: No
If yes, do you understand that you will be required to resign or abdicate from this position should you be elected to the Imperial Senate, and if this does not occur your seat shall be considered to be vacant?:
((MC NAME)): PapaFordy