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-Declaration o~ ~o~~i~c~~~i~~~itisenship
TO TH$ 3TATS AND OOUPI'1'Y TAa AssS880R,
st. Iaole- OOUNTY. FIARIDJ:
This is my declaratio~t a! Doa4ielle and Citlsenshtp in the State of Florida that I am stint this day in
aooordance, aad is conlormity with Chapter ~. seat~n 288.1T, Florida Statutes.
I was formerlir a lssal resident ol~~¢~ peane~p~_
~h) (8is~a)
and I t+eeidei at____--__1~_; -.~ _ , however, i iu-vecoan,~ea my ao~oiciie
to and am end have been a bona !We resident od the sbte of FlorWa since__~-------------1----_•--~-_--day of
_ ~_ ~e h ~eL. ; , 18-b4.. and I reside a 8isee~e---Rd:-
- ~
Lalossfood Park Fort Pisro• _ ~t.Lnei•.County, Florida,
(GYb)
and this statement is to be taken as nU- dectarattaet o! dtiseoshtp, actwl legal residence and domicile in
the state of Florida. _
((Ia.ac >rr. w partia~at s.eta. wel a...ti. a_[ ~aoy~r~ os bQa~o.... o: rdiovol~a! o~ .~mplo~m~ac .t
to~sas doeieilw ra~.o~:t et laasib to arw aoa~. v- ard~....t l~o..r .a.)
~ppl~ing for hoaeatsed
~~
°-~ ~ FIlEO ANO RECOROEO
~:,~= :~-
'u~~~r~'r - ~ ~N OOK -
-~-,~~3 ».a.. ~~ •-, ~ 1961 FE8
• ° ~,~,~ ~,~ .~,~'=; . ~. -2 AM 10:40
`~}-~~ `- `}~~:'•. ~ " ~~ ' ROGER POITRAS C?
.~: ,. CL K
''`--~~:= ,:~'i = C . ~ y ST. LtJClE C~';lNv~ c~ nn+n • .~
I FURTHER CERTIFY that I wW rssLrtee at my local atidnas whm the n books reopen,
and co~rtpty with sii other regnir~nh o! a te;pl resident o! this State.
I FURTSER CERTIFY that I have to intsatbn -to return to nq lorinee doonidk. aad I iatend to re~naia
~ 1+ort Piere• - ~ ~~,ppi,~ QonatJ-. Florida,
ptb caws -
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sworn to and wibseelbed bedoe+a me _ ~ ~~.~i,,,., ).~.,,.;',,~~ ~.
Boger Poifrae Q~~ ~~ c ~ ~'~ .` 1:'~'"~~'
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