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.DecIaration of Domicile
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TO !!II STAll AND COUNtY TAX ~
St. LGol. COUNTY.'~
ThI, It ":!. deder~ of Oomidte Met CItlIiInIhIp In the Stele ~ ~ .. J em filing'... .. 1ft ....... _
and In ~ wilh ChepIw 222. Secflon 222.17. FIorIcIe It.....
I w.. formerly alecMt _dent of_~___.J_UbOA.____.._________~_~_________, ___~_4!l.!-.I~______
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and I r..aded aL____I.9-.q~~_3____________.______________________. ~, I heve chenged my domicile
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to and am and have been a bona fide reSident of the ~... of Florida alra--___.,__-1_________________dey of
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--Jlu.Ch.------------ ___________,19 .61.-, and I reside at ----..2720-8.. -U.h-.s.~----------
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and thll ItttMment II to be taken .. my c:ledaratlon of dtDnahlp, IdWI .... ....... and domktle In the Sf...
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('-t ... MY .......... ..... euch . .. of "...."., _ ......... _ raIrt. ....... of 1T,1I,JIIle.A .. __ ......
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Entering Marie11en Mohr in 11th Grade
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I fU~,cst1lfy ~ I will regll"" at my local add,.. when the registration boob reopen, and comply with
a!~NqUJl~~,:-legal r..ldent,of thil State,
.....,..... :,..,.,JYI!...~'cE~~: ~J heve no Intention to return to my former domldle, and I Interod to remain In______
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,. . ~ :~~.:~~~~_~9iitt~n.r.u~----u-u---u-_-. h_____._h__~~L~~~~_~___..___ County, florida,
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Sworn to and subscribed before me thll 3 ,.___,.._ day of _AUlUA.tu____________UUh__' 19_'61__
ROGER .~' CLERK CIRCUIT COURT
By h~____~____________-_ D.C.
Notary Public
My CornmlSllon expires
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