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TO TS>IQ BT~Ti AIdD - OOt1'N'1'~` =1'A~ ''eta
~r. utcis ~ m~rn~r; siro~ii~i:
This is aiy- decLratian c~ Doo4ioiifi oad ~ tb. Ba-a os >~foRidu tLf~t I aa` mac this day in
aa;ordanoa sad in cantasmity with Q~apter fem. s.etba x.14, P9o:ida 8tatntas.
I was foennerly a 3e8a1 residsint of ~ - SORTS C/-ROLTl~
caa> caale~
~.,.~ ~ .,c.ia~ :at---sgJrs atr=s~ ~ --_... Ho'~Si;-~". i ~~ ~ my
ie~c .aa N~~ .
to and am sad base l~ a boi~ !~ react o3 tha Q*~tf ~- F~ri~h ~...~_~_-_-- L9th ___.______-day of
-------__~~~_~"L.__ , 18~, and I reside a~ ~~ Soaton° •~eane
lbrt Pieroe tl1tr..~t•aa xaa+8•e)
$~. Ln01e ^.Connty. P7oeida,
(Ci~r)
a>zd this statement is to be taken as ay~deolasaticn~oS citisaoahip,.~et~aL domicile in
the State oT Florida.
((Ls.•d bar• aq~ putin~nt taots, anal. as aal• o[ yrt oe boatiaw. a. rdinsoiahsoat et oa~siorMaL k
formo= domicib.:•mo~al a[ !ate to sw do~e~1•. a[ tioM. ~Oe.)
Hnabend is emDloJed inthis ~r• taati1 1~ •
Snter i ~ Aa. shill: Jshanl ]teJ 8i°-1'10]cltad ~ Jr. in }nblie aobarl.
FlL IQU'RECOINED
~ OK
1961 JIIN 30 AN 9.48
ROGER POITRAS, CIEQ.K
S1. LUCIE COUNTY, FLOi~ ;- ~-U/
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_ ('~i~nw Q7nridn.
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Johnny Rai Striakleal
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Sworn to snd suoacribe~ ,~ this---;IQ-~Y o~
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(To b• .z+i4~ ~ and ordinal Nod wills Ca•tic (~e~anit Good. a>td dnplkab wft>t 11at Aat~aoe)
Rnwn aaDD17 C•.. Plant Qh. ~•
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