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Qeclorotion ~~~o i ~ e ali~d Citisenship
TO THE STATE AND OOUNTY TA8 AS$ESSOIEI,
_„ga ir.L- * ••~ + . OOY,JN'I'Y, P'I~OBIDA
This ie my deay,ratidi of Domkile and Citisenship in the State of P7oriida that I am Slink this day m
accordance, and ~n conformity with Chapter 222, Section 222.1?, Florida Statutes.
I wss formerly a legal resident of-_ __ ~ _ Heat - oir~ini a -_
--~ia~3K-- ~a~~ --------------------- -- isct.l
and I resided at__---- -_-- --8oute_~_.`---------_._~._----------------------~----. however, I have cha-n~ed my domicile
to and am and have been a bona Sde resident of the State of FI since --.--`~a----- --- -- -- - ----- ----day of
D~ae~ber __---------_-_-__ 1860_, and I reside at____41Q~l~A~ .___~_-_-------------------------
-------- - ; ' (Strcet and Number)
Irort Pierce
Saint Lnais
-__--County, Florida,
(GYb)
and this statement is to be taken as my declaratiop of dtisenahip, actual legal residence and domicile in
the State of Florida.
fosaser domkile. r moral a ~tamib~to new domiefle~pnreeaa• a[ how. ~e~~aiaLment a~ emylormeat at
Entering denghter Tereea inn Yate~ioh
91U8~3
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F!! Al~ID ~E ,OEO
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i?6; .J,'I~' -3 Aid 9: 3
F:~~~ER P0ITf2A ~. Cl~';'1 ~
S~. LUCIE COUNTY, FL0K,U1~
I I~ UUgTIiEIt CERTIFY that I will register at my local address when the registration books rer den,
sad comply with all other requirea;enta of a legal reaWent of this State.
I FUKTHEIi CERTIFY that I have no intention io return to n~ former domicile, and I iaiend io resin
Port Pik ra a __~~, Soi nt eta ie _ _County. Florida,
tab) _-a~~~~U~'' ) ~~-___.-------
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cltTeaa)
Pant ltato~ict. a~„~L _ _
3warn to and subscribed bsiare as t~._..3.__ o! ~ ••"' •••` b s •<
J ; •~ IQ ~ '.. S
aanrrar , A. D. 1~ ~ ~ t;;-~. ~ ;y j ~ . ss ~.Q
sr Ppitri~, Clerk of Cirooit Coast ;}".~~: J{ ~`-;f..'~,~j'; ~;.?
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(Te bs ereeooed ie de~,f, ewe eei~6nl lied' ~ ~~c ~ges(fit CereE, aed
pwa ,{ay~la t7s.. mat ~.fts. 11~.