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ST ~ L iE CQlg1 Y+ fLA.
Declaration o~ ~o~n~ci~e and Citizen:hip - -
TO T8g STATB AND OOUNTY TAJC X08. .
_ Qt. I,roie - ¢ apRTIHTY. iZpBIDA: r -
TMs ~ m7 deelsratlcn a~ Domidla aed (ship is tLe 8tats o~ P'loeWa~at I am !flint this day in
aooordanati and in couformitP with Chayter ~ $eetion >~.1T, P'losida Statutes.
I was ioemerl~ a ~ resident o! IMrr..te - y ~an~dd-------
- - tatb) tam)
I -.~~/._ ~~~gSaLY D3~~• ~..M--.-r_µ-.~--. u T t a ..S.arsararl 7iiV ~v~w~
at-- LVwoitia, a ~.°i:v v.wyw ..y "'.
(~ aa+~ Nlslab~)
to and sm and have been a bona fide resident of the State os Fbrida sinoe____ $'-----------------------daY ~
8~ t her • , 18---d~,1 and I r~si~de a ~-___-- --
(~Nt aid Nda+be)
tort Pieroe .~ 8t, ~~i • -.__Counq-~ Florida,
-' ccxa~ _
'- and this statement ie to be takes as my decLratlcn os dtimnahip- actaal fetal residence and domicile in
the State of Florida. --
tom d ~ to arw~doao~Mea. poxlaaa d.~i/a~~~t of ea~pb7m~at at
1
•p~l~ing !or hoa~sie•d
,.921.317
FlLED ANO R~OED
` 800K
IN
1961 f E8 -6 PM i : OS
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I FLTIiTHEIt CSBTIFY that I will rs~ist~se st mr local addrssa wbes~ the retistration hooka reopen+
-~•"'~• •~•.d+ wi*~! ell ~~+.* *~.l.*ts ~ . _ 1 ~.nt tnR this
I >o CEZ;TII+'Y that I lave m fattntioo to ~ to ap Manse domicik, and I intend to remain
~_____! ~tsrt P~.re• - ~ ~ Conntyr, Irlorida,
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Sw~oes to and bt~s ars tMs...~~,dat o4 ` ,
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