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Declaration of ~I~l~$~~~itizenship .
TO TS>~ STATIt AND COUNTY TA8 ASSS8808.
sr.~u+cia oovl~rY, >N~I.o~e:
This L mIr declaration of Domidle sad Citiseaship in the State of P7orida :hat I am fllin~ this day in
accordance, and in conformity with Chapter 22Z, Section 222.17, Florida Statutes.
I was formerly a legal resident of White PLi~____--_~._~-__~. __--- Na>~Y~r]c_..________-
and I resided at-__--_.__~~---NO~tb~.- BroadrAJ--- ------------------------. However, I have chanted my domicik
i'_.. LL~~~~ (Strsst sad Nambsr) j
~- i~iitl ~l~it situ LS~e Vcc~l $ W~ tiitt~t~Olii$Lt lfi liit8 3~~ ~~ rii~a~ tiliiLe-_.-~a `~----------------:i:.j ~:
_ Pebrtisr~_----____-, 19 ~ and I reside at-__12~3.E8~th--~.-----: -
!'ort Pisroe ~ aaa ~~~~
St . Luc ie __Ciuuty, x'iorids,
tc~sv) -
and this statement is to be taken as my declaration of dtizenahip, actual legal residence and domicile in
the State of Florida.
(Luert Dere erp pertiaeot !seta, snsL ss nab o~ pert or business. or :rlinanjahs~eAt a[ empb~-m~nt ~-t
forms: domkM. nmo~al o~ lamib to new dom~ea.. ad ~o~, fie.)
91165
FI aND RE D
I: ___~.- --~~~J~K
135 J1?!? -c} PPf I: 57
Si. LUCIE COUNTY, Fl.Ch:~A C,e~
~ ~r!'tL'•~~~/
%T: . ~ 1t3.
I FURTHER CERTIFY that I will register st my local address whoa the resistration books reopen,
and ooaiply with all other requirements of a legal resident of this State.
1 t UAlIIL` 2L L~.I{rlil 2 t.aiilr t ni1t0 till lYiCttiiMii W a~Y1Y W YLf 1HI[a.0[ {NIIil1C/iQ, a{1Q 1 IIl{~OIIQ LO ie~ila
~ Fort Piera• St. Lnoi•
peemanentb. ~
Carl Rei.ahol~
t~ib+•a)
Swam to and sal~ibet}. bAtan me the r ~ dq ~
• ~ ~ ,', •
~~ .
.,,
(~ bf ~ .. ~~,.....:•~• i+~M oel~al !Mi w5tf1 (Atelc ~ C~eR e'! igifsr~ wit-'!'ai •ss~oe) .
a.we. MW ow. !tut Ckf. eta.
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