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STS L!![E Ct~TT, ft ._
Drcloroti~ . of D~icite '+~~ Cihsenship .
TO TSg STATE AND f70UNTY TAZ A88E8801t.
Si'. ~TOIf ppVl~Tl'=. lLOittD~:
Th3a i; aU- declaration o~ Domidle aed ~ is the State of l~'lorida tbat I am 9liaF this day in
accordsnoe, and in comiormitY with Chapter 298. Seet~ion 282.1?. Florida $tstntee.
il~a~ i~ew ~arae~
I was farmeru- a 1e8a1 resident °~ (alts) -- tom)
nt M ~tZQIItiA ~~4~~ v....... T 1..w wti.ww.~l w.r ~~1.' ~!
fais~i , T`°~ lSt._-_ ~V ---« «____-___-«___~_-.___. aaVw~tw~ • ~r..v w~..y_~ --~
- ~ ~a1sw~ .r ~.
to and sm and have been i bona llde resideant of the State of Florida since-_-- ly ----_.-..._._~._._day o~
.,: 4an-a ti'F.wA. T~leitd S~~lnite
~~ eab er ~ 19 ~ i i.+Ra j r~de 8 ~ rr ww .~...w v o ~ ~_. ~ _ ~.
Tort Pierce fit. ~$i M_Coanty. Florian.
..
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and this statement fa to be taken as mY declaration o~ citisenship. actual 1e8a1 resldenos and domicile in
the state of Florida.
cln.srs a.r. w vac tc~•. sow a...b~D~t ~ ~ ~~ at ~.tWoss~.t ss
lorm.r domkn.. r.®oat of lamas to n.w ~""' _
~13~-2
' dN0 RECOROEO
FILEL ~ : . ~ ...~(nnK
R! ~ 1 1 o Q,, 1, ~5
J.T ~~`
.~ ~ e
I FURTHER CERTIFY that I will reyiater at my local address when the re~Istacation books reopen.
and comply with all other-requirements of ¢ u.~t „n.uiont ~ this State.
• • ..-._
I FURTHER CERTIFY that I have no intention to return to my former domicile. xuu ""•":`~ `^' `-'^----
?ort Pi era e
~------------------------ icic~i----
permanently.
- ~..;; .
Sworn to and aubacribad.bldot~,;
Ja nub r~~~.~.~--mac
1. ~ t~'Y' •'
-__ , .
(To bo acoeutaa'lq;,,~~
Bov.~ aoDVb ~, PLsi C'lf~:' ~.
8t. I.tilcie «__-__.__«_.r«County, Florida,
thia___ 10_---day a~
7--~ A. D. 19 ~ .
-i 1
and eaitisal aMd ~ Ci~st t~eoit Coast. aa~ d~riate !~ T+a Aa.ao:)