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TO TB$ STATi SKID t70t1t1'PY TSZ ,
This is aUr ~ or Doaeiellw a~ Cljr ~ tlw Stab. of 1MoeidB tbat I am ~ tip dry in
` aooo:+~anos, sad is aoaiawif'- wl~l ~, ~tloa !ffi.1T, Florida Statutss.
I was loeaeer~l- a laesl rMi3~at ot..~.._._~[,.~i~aL ., .., --, __._~i. ?.~._.
iayl (eta.)
and I resided at'~ .~iAliiLlLe_..Lali~il~. ._..._._.___. Ho~warer, I hsns ehaapd mIr domieihi
(Ns+K aa~'iaiwwr)
to and am and have been a boamt !~ ~+eddent of the Stabs ~ Florida dace---_-_~~.~.._--~--____.~__day ai
tT~L_ ____~, 2t~._, sad I reside ac >tt~ e;-11>stw alas j,~,nDe~ P.rh
taa..c aaa xta~e.r) n
tort Pioros st. foie ,
(ab) - - ~ .. ._._.t~onat~r. Floe~ida,
and this statement i. to be takes as my deelaratfaa of dtisenehip, actosl legal residenos sad domidle in
the State of P'lorlda.
ttltwst des aas vet fasts. ai as Malta ~ w Mnista~. ~ raU~ai~ir~eR d taylot~rt st
fasanr doatidlw rsso+al td tatdb io at~w ataa~s~iN. w~r~w ~t ~ea~r a/a.)
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I FG ATHER CERTIFY that I will at my kcal a-ddresa when the retistrstio® books reopen.
A.,.~ ~*!~ply pith all ~*~~ .~..~;.,.~.-~~; ~ a lit .+.~~..~t ~ tt~l. a+,~t.,
I FURTHER CERTIFY that I have ao intention to retnra to n>, former domidk, and I intend to re:nsin
in_ ~9.~!__ ~l~4~ ~___, St. ~itr ~ _Counb-, P9orida,
~ (Clb)
permanentllr.
(Naaw) ~~^
fat ~t8Ph7
3~arn to sad s!ibeeslbed _~ ~is.~~....dq of
_A• ~,_'
>~c, co~nmiaeioa
(Ti be rswt.e;~ri ivi~,~lt~iaal 1Wi vrltlt ~ t~ aaeR foal ie.ii.st. with Ts: As~ataee>
K.• NlNli••. ~ ,.:
d•>t~ eytai7 Cfa.. Piss: C1t1.'~,¢.y..