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Dectarotion o~m~c~~ and C~fizenship
TO TH$ 3TAT19 AND COt1NTY TAZ A88i~184R~
8t . Ixaie- CpUN'i'Y~ ~IDAs "
This L my decLratioa of Domicile a=-d trip is the State of Florida that I am lllint this daI- in
accordsace, sad is c-0t~f'ormitp with Chapter 2lZ2, Seetion 8.17, P1orkL Statgtes.
I w~ tarmerUr a legal resit of _.~ ~..~01hI1TE, - Virecinia_.`..
(d4) (8eata)
~ .-. ~ w~ _ 5th-w.~..w ~.~r~ FX~w~w~t~ li~V (*AZ'1~Ci~
and 1 resided at---------~~'-*- ~---I~w._~.i`Y"------------------ -
_ (S~ast and Nnsb~z)
to :.:.d a.:. sad h^:'c ~*~ a ~~ flde resident of the State of F~rida since_-___-.-18th----------------------day of
---__~$~~-------+ 19~ , rasa I rMrtide at------~--'~+---~-'~?.~'`~+Zt~~oII__---
------------ -. cstrMt sad lVaai~ti
----------- ~t~P{eras, ...$t~41st_ ~_.__...._..~_County, ~~•
--•
ccxa~
and this statement is to be taken as my declaration of citise®ahip, actual legal residence and domicile in
the State of Florida.
(Invert 6sre aa~r pertinwt fasts. wcL as -sa1~ at Dro~t or a ~e~~nLhmeat ad eopio7m~at +t
torm+r domicils. rsmo~al o? iamib to nsw
Eatering John R+oy Stnnp in Junior High School
~rtcz{"°: 4e?~ Eugene Burf~i in Elementary School
Bitty Hall Warlord in Elementary School
Anne I.ee Burford in Elementary School
panne Yarahall Burford in Elementary School
912Q;~
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\ 1 •I J-.
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- --11 :':~' 1 111 .':
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I FURTDFR l`.F.RTIFY that I will register at my local-,address when the cegystration hooka reopen.
s,.d c=~nlnly w;{~s all other re~uirementa of a legal rafsid~t gi tnia Siaie.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
--___Coaaty, Florida.
~,. -;, . ,c", ~ -Y ~- ~ lhranlc Yarshe t or
~: J f . ~ : f ._Oreag~Jsa...-Ezt.e.ne.i~;~Pierad,l'~~.
.. ~i~~" - ~:. ~'' (Address)
g . ~ to ahd ~bs~ibed beiare me this---S3ih---day of
- ~~ .... ~,,.~ - A. D. 19..14].-.
g08 'r - ~ CLERK CIlEiIIIT COURT
~~ D.C _
(To b. es~eatsd fA aorttesa sad orislnal slid whit CMsk (~reoiE Court, sad aaalkaa with Taz Awssor)
Bnr•e SUDD17 CO., PI~O! C1q. ~.
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