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ST. ~~~ 1I • ~t ~R.~ ._
~CfOrQtlOf~ O~ ~KI~Q affil
TO THE IiTATS AND QOU~1'!'! TAZ A
ss.~a _ ~ oovrri~r.~ a~o~s:
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Citiseffship
This is mI- declaration as Domidk aad Citlseoship in the stet. of P~oeida that I am ~wuc this dey in
accordance, and in ooniormity with Chaptsr >~, $ectioa 2~.1T, Florida $t#ntes.
I was iarmerU- a 1eeal rssWent c~ ~~~ -~--
tGtgr) i~.l
and I resided ~Ch ~~~ gtg~alt 3'. ~.', ~r,....«..,..~ I rr.....,s _~~~..~ ~s a.....;..~~r.
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~~..._.--_..__.~..M- ~.._.~~`_.-.~..-._....._..__..-..• ~ivi. ~~iii Siali Yti iitii '
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to and am and have been a bone fide resWsnt o1 the State of ,Florida ainoe________.--$~ -----------___day of
Nore~aber ,A ~ ,aril f wins ai.._~"+~ ~~~ CGS
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tort Piero • -- _ ~ ~-~! ~_Connty, hlaarida,
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and this statement is to be taken as my decLrsticn of dtisenship, actual legal residence and domicile in
the State of Florida. _ _
torser doaleiN ~ ~~ ~w dod3aiM. ~ at hots, ~t~ d Est at
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~!. L~CIE COlfN1Yr FLGht,,A
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I FURTHER CERTIFY that I will re~iater at my local address when the re~iatration hooka reopen,
slyd e:,mply sv;Lh stl cL~er regale-in~;ia ~ a legal rr+easarui s,i '~.':s+e n~~_
I FURTHER CERTIFY that I have no intention to return to my former do~icik, sail I intend to remain
permanently.
Dort Pierce
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3worn to and aubee:ib~d, bdiaa~e ~mbS,
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(To b. trs.eot.a bt doDlkats- aril or~.v ~ w!!f comet Cinoit Ceoet, ..+ ar+kat..wt 71as A.....ee)
St' luaie Coanty, Florida.
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