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Declorotion of Domicile and Citizen p' ~~u~ cou~rrr, F~~.
TO ZEE STATN AND COUNTY TA2 A8~880>t,
Tisis is my dscLretion o! Domicils end (~tbsoship in the State o7 Ploelde that I em ~ this dar in
accordance, end in ooniosmity with Chapter 4.88, $eotion X8.17, Florida $tetntes.
I was tocmerlY a kRal resident ad ~losonto t'~~da
tptp) (81aa)
and I resided at___-_~ ~~Q ~m~ ~•d{t ___ _. However, I have charmed mr doa~ieile
(84wt aid ) _
to and am and have been a bona Sde resident of the State os Fioride since_~--_1_____--_--___---____day of
____Jw~r - _, 19 ~, and I reside a~ ,'~32 St. J~_~~a 14t i~.,.~,is Rd.
(Bte+Nt sad Nnabw) - .
lrort Pierce St. Lnoie ~~~,..
--
(C[b)
and this statement is to be taken u my declaration ai citisuship, actual legal r~esidenos and domicile in
the Stste of Florida. --
(cInMrt bra ant vet tads, sneL a• ~al~ a[ or badura. or r~lisgoLLs~t a[ ~spb~swat at
tora~ dotiie~. t~o~al od famib to ~ domie~. parer a~ dose. fie.)
3732 St. lhcansis Roads St.Jaaea Park
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!9~/ fiF$ 27 ~ I: ~ 3
UROGER PO1'fR,~S. CI'"^Y
A~
I FURTHER CERTIFY that I will register at my local address when the registration books reopen,
and comply with all other requirements of a legal resident of this $tate.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
~ Fort Piea~ce _~. Tanaie _Connty, -Florida.
r~~
permanently.
Sworn to and subscribed betoa+e me this.-_71______day a~
February ~. D. 19 61 ~ `,
Roger Poitra~a. CZesk ad Circuit Co nrt y'
(Naa,~)
Sarah Jesn Da,Flos_ _ _
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.~ t(~U I ' '', ra
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(TO be tseeatad 3n daplkab and ~~ wits CMelc ~~
Rn~n 8U OD17 C... Plat C1b. tel.
-.cq -•~.~~~11
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