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~#~~o~on ~a~ i~,~ au~l~ Cihsi~ ~,
P ,.~
To ~a gr~~s~ a~ ~r~t~ loan.
This is air dsolazstioa et Do®ieiia sad ~ is tM :~ et Ffo~ridn that I ass ~s this dq in f
aooordanoe. and is oonfoemit,- with t~apter ~- $istiop 7~
I was raemer>ty a 1KaI radd~at a~---,.-------~1~. - ~i .
cc~~ -:
914 8. 19th ~. _ (~)
snd I reddsd at_--___--- '-- ~_~ Howe4err I have obaa~ed ralr daauicila
_ ~ tip eai ~itvrete)
to and am and have been a bona !~ rMddent ad< the State odr Florida sinos_ al9t_____________.~_...day o?
Saytaabt-r ~ 15..l~. and I rssids at~1.G!>I~.,.~~ ~.~. ~,.
(~tewt eat Nof.Mr)
_ Fort Piese• ~ 8t. Lnoio ~_Coanty. Florida,
. ccw~
and this statement is to be taken as my deolaratioo od citiseoship. actaal ksal residemc~e and damieile in
the State of FlorWa. .
!o ~ ~feil~i- ~ ct t~~s ~ ~ do~te[N, y~i a ~i~e~ at ~a~wt et
,,,
~ ,~,:1~ ~l "-
~.~.. A. D. 18bL.
I FGRTIiER CLP.TiFY that I will register at my local address when the r~iatration books reopen.
and comply with aA other requirements of a legal resident o! this State.
I )r'URTHER CERTIFY that I have no intention to return to my iosmer domicile, and I intend to remain
in_ ____--------t.Qrt Piers • St . ~o i,~ _Connt7. Florida,
(Qb) ------. -
permanently. •
t
(Nast,) _____~_ ___.
>1~1ttt ?ittel.
Sworn to and wba~i~
Jan ner~ i~~y4
~ ~/ Notaa,;1
~ .
(1~s ba rneo(oti
so... novas a•.. rwe pcs.
bei?ac~ me this_.s~___day of
.-
at
91113
~i 0 A 'D RECO
iF __ OOK
19b1 ,1~1t~, -3 AM I I: 34
KUG!~R COUNTY. FLOn~~A
Sj. LUCIE
tAiaewe)
W ael~laal Mtn ~ (Ste! weft Coeet aai wit, 11t: Atattatt)