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Declaration ~f ~~ ~~'d CitiYenship
TO T~ 8'rATE AND OOONZ'Y TAZ A848.
Q- * --~ ~ ~ COIJNPY. 1rLOjtIDA:
This is my declaration at Doeokik and ati:.nhip is the State of Ploeids that I am 2~ this day iA
aooardaacs, sad in conformity with Chapter 432, Section 222.17, Florida 3tatntes.
I was ioemerly s kpl resident of ROOY~_>rouaL _~_ ~r'ChCeroliAe
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- caa~
and I resided a~•OBOOt343~_ _______________________-. however, I have chaa~ed my domicile
__.___.
- (8t~t gad l~Tob~r)
to and sm and have been a bona sde resWent at the State of I+Zorida since-----------~-------------------------day of
a~~ 1.~~~.. ,4 as a,a I e at__~_~_.llt saet Arbor A~enne,__ai~er Park
Fort Piero• gt. L
oe iel M -_-wi~iaiai, ~ 'a1~uw,
(fib) •
and this statement is to be tslcen a. my declaration of citisenship, actual legal residence sad domidle in
the State of Florida.
((Ios~t l~ aeV ysrtiwnt facts, wed as sa1~ a[ or bndaMa. or islLgnL~m~ot aI ~D1o7~aL d
later d~kil~ r~mo~d at faedb to srw doaileiN. ~ d yon. fie.)
Applying for ho~eatead -
9135 ~ ,; , •,..,;,~~:::. 4 t;,;;,,, ,
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FilEO AND RECORDED = `~ . _- - - .~~'' .-
:. ~.
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1961 JAN I I Alf I I: pg r?' ••~ • ~~~- •~ `-
ST. lUC1E COUNiIr, FLOii,~A
- /.
sad olomF~ b at a legal r~eaid~int ~ t1~ ~ when the registration books reopen,
I F't31~~ that I bsso ao inta~a tQ re~tara to ~egr toxsmer do®icile, and I intend to remain
~ lost Pierge y fit. Iatei~ ~,~,. Fbeida,
ccw~ ~
pew. - ~ - .
• ~ • ,: - (Misr) .
- - yes ~,,. n~•- ,_ •
~~.`3,* - ~ A, D. 1261._.
J •r Poitre~-~ab~rk o! Oirer,_Yit Cagr1.
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~ ~ !~ ast e!ldaat llbi ~xM1a Ae~lc Amt Owet.-aai t+lr~ 'M lss~a~e)
a.~.•a essv a. pi~se t7V. sn. y ~ ~ ,. ; ~ .