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Dectarotion o~T1~ mKe an~ •Citiaer~hip
TO TH>~ STATS AND COUNTY TA% A88E8808,
3T. LIICIE C0Ul+Tl`Y.1lrT~SIDA:
This is my declaration of Domicile and Citisenahip in the State of Fiocida that I am 1Uini[ this day in
accordance, and in ooniormity with Chapter 288, Section 888.14, Florida 3tatntsa.
I was foarmerir : ~ resident of CII8~I1~1iGTTI __- --- ~C .___.__~
(C[4) (Stab)
- - -- - ---
~~ 1 r+a!~~~ at__ 80ltt~__ l~_33!t;`11*_L~^~ ~"sfa _--------•--------_-__-. Hawever, I have c~lsan8'ed my domicile
(etrat sad Ntaaa~)
to and am and have been a bona fide resident of the State of Florida since~~_--_._-..._-_-~----._._.__day of
---
Yarog 19d~ , snd I reside at__~__. dub avenue ~, ~ui+3.6:-~ v:~..a:-8
cf3tt..~ sad x
Fort Pisrae -- - gt.Lnaie W__, __County, )Hlceida,
and this statement is to be taken as my declaration of citisenahip, actual leSal residence and domicile in
the State of Florida.
forme: tiomk0~i, tumoral o[=i~aa~- to now domle~. pn~La~ a~ bozo. ~be~~nbbaont a~ ~npto7smt at
,....,..
., ~ ,,^:
_ :. ~ _ :.
i ii-Tiit'i'iiM._R_ t':FF't ~ i__i•'3i i'nst I will resrister at my local~ ~ad~~dress when the regiittration books reopen.
1 _-~.~- 11 at .,- i.......er..i. A~ .~.. ~n l.~P-l i', Uf W1J0 State.
ana t~ir-ply W1G11 wu u~ii~a aa.y+iaawu........ ~~l Z'p!!-
I FUItTfiER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
. Fort Pierce
permanently.
~~~
Sworn to and aubecsibed~~~•~•~!----13th, of
a8nui~rl _~:~, ~~ .~ f •` •~. D• }gal --•
My Commission ~axpiteic~,,;~..~-#.: ~ •~~•
(To be eseeated.in
gnw.w t;aooh C~.. P-ret CIt1. Tla.
hd o:iSinal filed wltb (Aee1r Cireuft Court. sad duplkate with 41as Astiweor)
~ - -~
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`J14:57:
FILEL~.AND RECO~D
N ~7 G E R PO ITRAS; ClE"+K ~/
Ji. lilGti CUilfiii, Pi.iii+i_.F ~
3t . Luc ~ _County. Florida,
(Naas)
agot_CarlrSvuss
_--- ~~(Addtwe)