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t~eb~atia~~~~~om~rid CitisemAip
TO THE l3TATR AI11D OOUNTY TAZ ~0~.
ar. a,v~ras .,....s.... `..,,w...r...
This is my declaration ~ Domicils •ad t~tlsi4ship is the Buts of I~orida that I am ~ tl,ia day in
accordance, and in ocaiormity with C>as~ter ~, l3ection x.17, Fla:-±-;;+ Statntss.
I was lo~medy a .1~ twiasnt o1 di~neia~tt __ Ohio ..~____
taa) -' csr~s)
and I_resWed at__.__~$~~ 1Li~ds~a ni.raL_. _..__-• ------.y....... Howeter, I haw ohaa~ed my dosnicik
:,. __~ _~ ~•~:; :.~~:- •..~ ;, * r~•-.!~ ~~oaatisa)..~. ~.*. art - - - 4 sines....----_*-------___.___~_day Oi
._ u~tt - _____--. 19-D~-, +md I rssieis a: , ~tt• ~ ~.~._'~-10 Pe1~ ' ~lls~.,~
_ - tsawc aad r~a.~) a sw~ rl[
?o=t Pi~o• _ _._, tt L- e ~ Y._C,ounty, P7orida,
(Ctb) ~
and this statement is to be talcan as my deolaraticn os dt~soship. acaul >~ residence ind domicils in !
the State of Florida. -
!~ ~a ~ios~s i d ~~il~~ o[ ~aD1v~aM~t at
911:-U
fit Q 'D REI;O
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1961 J~h -3 AM ~ ~ ~ 15 ,
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1GER POITRAS, CIC~K _
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I FIIR'1~iFB CExTIf~Y that I will ra~iste: sb m,7 ~~ w6en the re~tratioa books ,
and ooaaply with ~ other raquit~'~ts at a ls~sl resid~t of 8tste.
I F'Il'BTSBIA C,~TiFY t>fat I bmn m tbs Y+stara.~ sU! toeaar domicile, sad I iatiend to r.®ain
mac ~ ~~ /_ l~ /
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tT. tas weesei~~irt~wiirl~r'iM ~ ~ t>h+nd4 OAR sti !~M ~-',lWc ,Aswsse)
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