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phis is r,^y declararian of i:?omitiba arxi Citizenship in thre Stets of Fiarida that I am fiiir,p this tiay ir, acr~rdance,
arxi in Conformity with Chepter 232, Section 223.37, Florida Statutes.
I was fUrmeriy a legal rosidor;t o€ 4 ~i)piC~ - l~i • . _
tCi!-1 i5tanr)
and 1 rtraiderd at E7t ~ _ _ h30r~ovar, i have chengacl my domicile
(Yraat and Riv+ntaw)
to ar•,d am and have been a Mona fide rasidont of the State of f'Icarida since 1~Lh - day of
- - 5 ~;t'T:~ .~. -;EZ 14 ~'~ , arx~fi I ~C ~ E!::•'.% ~_ Dpi. _ - - - _ - - - - -
rr9sida at
(Srrrae •.sd rivm3rar)
~'~. p7~RC~ _ ----• - -- -- --- _E''"~E`~:CDI~ _ C:o+unty, Florida,
tr'tY)
and Chia statement is to be taken as my declaration of t~tixenship, a.-tual legal residents and dnrr.iciie ir; the State
of Fbrida.
(Ines+r Fwr..ny ptftirwnt faesa. reach as vela of ~,rogsny w bvs)rwas, ar roNnga,ldement of empbymoret rr ton+ur domte~la,
rwncval of family b new domieita, pu~rcAasa of hoeces, aee.)
EI:T;i'St:C C?E (~.} C'rEILD iPd PUBLIC S~~F{C)OL
SYi~~,FY 1~E,Itii~E K''~"rc;r~ (6 yrs}
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(~~ S~.P ~ f f't1 ~: 59
RO~~R P~'TPA~, CLERK
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1 ~PRTI~"~R C~R71FY that !evil! rt~istt;r at my local tac{dresa <vttrsn the ragiatratior; looks raca~sr,, ar~;i cxympiy ~,wiih
s!! other rr~:~ire;o~etta of a logai rrssid~•nt of this St3~.
11=liR'1'I~FR C`~~Tlf•Y that ~. 1^.aere tier ^.ntern#'srrt to retort, tc~ my forirser t'~st+aicile, ertd 1 intend f4 rerr;~in in _ _ - _ _ --
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