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- ~arot~on o~ - ,iw1e - ~~ Cit~sen~,- - ~ •
X71 • fNVi~ ~ ~Mi~M~~
'I')b~s li ~' deCl~Oa ~ Doloidls alld bz t2N State of ~IotWs that I ~ 1Wna thb day in
acoosdanoe, and in oonioe~nity with ChaDta' ~. 8eatioa 9!8.17. Floods St~tntM.
I was foc~sr~y a lop! rsaideat a~_ ~~-.--..t ~ Y~ ~M _ro~
--.1 ~ tCM~1) (8~)
~dt ::~;.y°a 8`----~-f '~~'-- 7w~ A~ww..~ ~.:.. Q ~1~+~ sw.j~j~e
rivaa. \ ~ ~-.-.---.~--,s 1~~.1~~~i ~ #TT4 !~ LL! MWM1iMIo
to and am and have been s boos llde resident o[ the State od FforWs sines..,~~Qth._W_--_~_---_____dar of
-- Decambez ~ 19~. aAd I adds at 1VZ~ 8 R 16th - 3~lRII~ -.
Fozt Pierce _ Str Lnoi~ ~~p,, gam,,
and this atatemeat ~ is to bs taken ss my deeiarstioo o~ dtiseoship; aetual le~sl resideoos and donsicile in
the State o! P'lorlds. '
t r~srr do~sfeit~ r~a~ ~ to ~ aosie~. ~i et ~ie~ ~ ~
,.,,, : •:
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911.15
Fil D D RECO
I~ ~I~~X
;; ;. ';CIE CCDNT'i, F+ ~+ ~~
I FURTHER CERTIFY that I will ra~ister at my k~ca! address when the re~iatration hooka reopen.
and comply with all other requirements of a lead resWent of this State.
I FURTHER CERTIFY that I have no intention to return to nxy former domidle, and I intend to remain
i~__Fort Pierce ,_, ~t_ Luaie ~.______.-__Connty. Florida,
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permanently.
Angelina 3pozto a~
Sworn to and ~ii~ec~ be~oa+s me this_~.~_day a[
_ ~.~ .~, A. D. 19 61
]~-
is at Ler
6/Z116~
cnaa~...~
(ro bs .:«v~i~ L d~liaa ..a ~.d ~ .rNS a4rt andt A.aeR •~d +gtfewt. wars ~ as.wree)
Boa. stiiNs a-. lh.c cks. r..