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t~eciarotion o~~ac~i4n~' CitiYSnsbip
To T~ cress exn rw Tex esas~o~,
q'~' L~3CTZ CO. OOUI~I'1'Y, ~LOBIDes
This i; my deeLratlon ~ DooeioiM and is the State of I~losida that I am !!tins this day in
acoo:dsnoe, and in cootormipr with Chaptyr ~, t3ectiaaR >lgt1T, Florida 8tatntes.
I was focmer~y a lap! rasWent of tom) -----. -----~,r~t~) ------
aad I resided at_.. t9SrII~IO>i AY=. --_-__-. However, I have chanced my domioile
(dtraat sad I~t~~bar) `----~..__-_
Lo ~d tm srd ~~o z~-ca a hone ttdc ~: a+ tze Staffs- of rutrhia siacx-_-_.. i6 v-._-.--- -- -'-----_--cis of
I~O~ _____~ 19 ~, and I reside at.._~.~jiats Bl~i_ ---
T-:-----
Fort St . ~Ltioi• tom: '~" ' ~) -
«xa)
end this statement is to be fatten as my declaration of oitiseaahip. actual local,, residence aad domicile in
the State of Florida.
((Tassel ~ aut- yartjaaet teats. sne~ as as~1s ~ ysK ~ besiesss. ss rsliseois~rant ad aa~iopan~t ~
torsss dosddla. zaaao~sl a[ lat,W to nsw ai ~a^Mr eM.)
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~~ ~_ _ -- - - ~ODK
~R PO{TRAS, ~l~~~~~
;;~:. l!~Cl; COUNTT, FLGt;:~A ~~
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,,: ('~••: ~-. .alt F ~•• t-
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I F'UBTHER GLSTT>P7C tous I wDl r d nUr local addross when the resbtration hooks reopen.
and eomp~j- wkh all o requirmeots ~ s IeAI r~ddwtt o~ tMs l~latis.
I F'1J8TSEH CERTDrY flat I gave Iq intentka to Musa to ~ toesfeat doodk~iN, and I intaad to remain
is ~"~ ~_ ~ •-, 8'!~ I~CT~--• -1-. l~orida,
PAW talV)
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