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Dscbrotion o#T'~~Cilis~n~ip
TO TSE STATE AND COUNTY TA2 A>3B~80E.
~; La3,e GOUNi'Y. lLORIDAt
This L n0.V ~ ~ ~~ sad (~aship id the 8bte ~ !'fo~ida that I am !U~ this day iu
accordance, and in caafozmity with Chaplet 8~, Ststiou x.17, F'dorida Statales.
I was ioemerly a ie~al :+esideot at ~! ~I s••t= ~ ,•~t i .>,.
s ~ Se..~. i a `~ i `~ wi ~..;f TiTr ~.~~.~~.. i ~~~q LL~wr «~_ f w`~.~~li
and I rnsuiat :w----------_~: - :;~...._.._._~.__.._~..~,___. :::~ ~ ~.: «:. ~ ::;:.Y :. - _-
_ (8treet aaa Nm~bslr)
to and am and have been a bona lids resident o~ the State of F~orid~ since_~~----------..-----------~-Y ~
-----Jenusr.~___-_-- _-_-_-_ , 191, and I reside at t~~ ,t-ennw B __
- («ewt ash No~b~H
Fort .Pi ero a 9t . Lno i • ____Conaty, Floeida,
and this statement is to be taken as mT decLtattati of dtiaenahip, actwl lepal reeide®oe and domicile in
the State of Florida. _
for ~ u~ f~aeib ~ ~ do®~e, ~e d ~iM~ a~ ~7aMat at
Entering Carol Holden in 38 th arede
9191
~.EO At~O,REC OEO
OOK
IN
30 QM 10: 02
1961 JpN S CIEaK
„~~Q pc~ITFtA_~~~;,,r~.~l~
Sj lllClE COUNT'. c ~~,..... _ 7
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t .,. ~;.. . ~.-
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I FURTHER CERTIFY that I will relater at mY local address when the registration books reopen,
snd CADlpiy ~ILSS »!! e_aes r1~1te~~fT_-~~ldlb va o ica :: wo%::c::~ -= - ----
-~--
I FURTHER CERTIFY that I have no intention to return to my former domicile. and I intend to remain
3t. buc i e ~_County, Florida,
im` lrort~pieroe ______Y _ ~ -------_-/,
(cat,) ~G~` G'.Qlu~-
permanently. ___l_Y' c"e-~--- _____~~
(NaaM)
l4srtr Holden ___-___-- ----
Sworn to and subscribed btiore ass this---~y- o~
er poitra~~Clerk of CirauitCourt
~,
••.
~ 4
.; :pct,+r
,,~~`~ ~ }are ~(r'
s, ~ _
(~o be eseented in dnnlieats and or[ebiai sMd wftr C~e~e~ (~soit Cooef:
µ~An soDAl7 C~.. PItOt Clt7. Iha•
XfaMSOr)