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Declarotior of Dom cQi~e a'n~'Cifizenship
TO THE STATE AND COUN'T'Y TA7C A888880R.
S~ y uI- I ~ -C70UN'rY. 1~'LO~RIDA:
sad (~tiseaship is the State of Florida that I ass Aunt this dsy in
This is my declaration of Domicile
aocordanoe, and in coniormitY with Chapter 2ffi, Section 222.17, Florida Statntea.
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I was iacmerly a legal rest oi.~~GXLL (fib) _._._ - -- (~~
~_ ~ ~ I '~"~ nPV ~y ~ n ~ P__ , . ,f~pj:. _l'!f'_ ~.4aZ. However, I have changed my domidle
ann 1 resiaed aft.---~-a--'--'-----~---- aid Ida~bw) ` ~L
*.. Art a~ and have been a bons llde resident of the State of Florida ainoe__--7~'~1L..------1-9 -------------day of
St Qucie y cna~~..11Q~1~ ~ ~x_~~~~
----~;:,,_ ~/~~~_-- -- ~ 19 , and I reside at_-_ -- ~a.w.. Nna+~l t-
- - ~Qrf _t~1G ~C~ ~: _ L ~ e e e `r'_`~ - - - ____ county. Florida.
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and this statement is to be taken as my decLration of dtirenahip, actual legal residence and domidle in
the State of Florlds.
(Lwrt b~ att7 vartitwnt !acts. tme]- v sab _ ~o~i °t a~~oaN. ~e~ o[ ~o7Mat eL
!orator domkila. somo~l of fata~l7 to now doanit~~.
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/~e~in v~s~r~,rnf' o~ ern~vloy~en
p
/ o f ~ar»i ~y/ ~ new comic%IG~
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FItE AND RECDR ED
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I° J~' I ! F" 4:04
Si. LUCK COU4iY, FLGn~uA
Q r T~~'rnCl^ Q.O/f11 C/~~E J
~Jur017ase O~ ~orr~ anCi/
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i Fi IRTHER CERTIFY that I will register at my local addrot-.sa when the registration books reopen,
and comply with all other requirements of a legal reaideni ~f i. ;,s ot,.`K.
I FURTHER CERTIFY that I have no intention to retur:- to my former domicile, and I intend to remain
,
,~~~~~f e, ____________~_County, Florida,
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permanently. __ -----------
--- -----~____-_ (NaaN)
CHARI.E9 B. CI._AG$'T'T ----------------_-__-.
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Sworn to and subscribed beTore me thia_~ : ~ ....~ ~• < <; " j,~::
T~NIIAgY _______---- . A. D. l~_~l `~'~ ' .~ - ~.~i ~. , ~--
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POITRA LERK C T COIIRT = -'
ROGER _ .
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y- (To bo e=aented in dnD1~a +~ Aiad wf4t G~r1[ (2t~enlt Ceert. asd tfiaplksta wkl ~ Armor)
Bowe ItcaVtr Co., PUet Cltl. ~.