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Declo~b~ibll~il~dlail~ila and Ci~izen~ip
TO • B~~T$EAND OOUN7l'~f TAX A~B60i~ .
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This is m7 declaration a< Domidis aad Qtiseesilp in the State of liorida that I am ~ this daa- in
aoooraanoe, aad in ooarormity with cbapta 1E88, Seetion 8lS.17; Flw~ida 8tatntes.
I was larmrll- a ~ resident of D8E7CEL HILL _ PA • _________.
caws ~' csas.~
sad I raided st_ 460 __Burnle~-I~sns ....-..._.____----. Howe~rer, I haw. changed mP ao~i~k
tets+~t eel xo.~eee) 17th
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to and am sad laave ueen s 4ui~i aa~e -riitlmi c~iae+si~ste iu ~"ri~wi: s:avo_------------------•---_---=-=---_..a.°.,`,' a#
__ ~Pril ~.~, 1A60 , and I reside a 160@ Ze~h1-r Avg ~:~._.._.~._
- (ew.c asa xoarber) -
~.. ~ Tiii~~ ---Couab-. Florida,
(C~b)
sad this statement is to be takes as my declaration a~f etti:eoship, aataal legal residenos sad domicile in
the State o2 Florida.
(I~t dre sap pertio~ot fasv. wei ~s a~b et ee bris~w. ee ~t at e~Wo7awt at
fe~~ee da~kiMr reso~~l d tastes b saw iewaea~. +~ tip. eM.)
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FIL AND RECOR ED
IN ~... 800K
. 195 J!Il -3 AFi,ll: 33
[i~]GER POITR`AS, ft~'Y
Si. LUCIE COUNTY, FLQK:,A~~
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I FUBTSEB CRATIIr'Y that I wiII register ert mar bell addevss whm the t~ratlon books rcapen,
sad compb- with aU othee ngnirements at a MSaI :+ssiiea0 a[ tidy Htate.
I P'IJIi~B that I base no to raters to ~y tcRme: domicils, atad I fntead to remain
~ ., $8CB _ SS.ZOCI Oomb. Ff~oeida,
t • Jp~'o, lCUsr
~Q s" ~~ ~ ~ ~;' ~e~
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ts~ w ~.r.+ r ~iieuls asl..e~ei ~ - ea. ~ ~ ~1oeo.Md
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