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~ro Taa s~rsTS ~ ouc ,~ .~>~. _
Tbia is aAr ~~ ~ Dorms end ~ ~° the Sbta of l~'iarWa thst I am lllins this day in
acoordanoe, and in coufannit~ ~ ~'~' ~' ~e~ lS8.17, Fio~ida Statutes.
I wu iormed7- • lelel resident of._-_.-----•~d[ i,•,~~` - (~)
Oa~~diaY >~. _. HoWSVer, I bare rhansed ~- daeniciie
and I resided at_ a9 - .--... _._____._.._~-._
ideswt a~M Ne•Mr) _ ,~_ ~~ ~_ ]l.th -_----_ dap of
. -
--------------- -
to aad am ansl h+a±~- been abona -Sde resWent of the ~u a~ r .~... - ___-_-_
_ _ Antiber _._.. 1~~-. ud I reside at.. ~.- ~~ ~i~
taae~ •~+ x~~
_ ~ ~Sr~ ~ ••~ • - - 8#, ~za~0 i! ._.__County, Florida,
(ab) aetoal kcal residene:e and domkile in
and this statement is to bs taken u my deciantiao of dtisaoship,
the State of FiorWa. '
to~r~s d ~ ~o nrw~ioslew. ~ d•~iN-~n..at d Msnio~s~ ~
~\ ~ ~~ l.,'1 S . i~,C' I.
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92134
FILE .AND RECOROEO
~N~~BOOK
1961 FEB -6 PM ~r 31
ROi•ER pQITRAS~ n~~R A ~A
F'° that I Will re~a addreu When the ~tration t-ooka reopen
I F'JRTHF;ti ~n i•I - ter at mY local
and comply with all other requirements of a leral resident of this State.
_ ~ t s«ae«~i ~n vatn~in
I Fi]ItTHER CERTIFY that I have no intention to return ~ my former domicile, u-u • .,,N.-•.. -- -
~n Dort Pieroe _
ca~s~
permanently.
9t. Lnoi • ^_~-- _County,
-- (/Joseph Xil
( rlf61a7 v ~~~ NX~' (~
_,-~--- - ~-•'-- Ij
Sworn to end su~~~~-. 4_~__t..h_~ of
2~
' r : ; y bNd with G7ert (xreak Cwrt. +~ fit' "~' 11~c Air)
(7b M es te`~~ sAd -si~Ma1
wn.rwn BupD~T CO.. PIaOt ~~• ~•
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