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Declaration of Do ',' ~~t~C~l.~~"=hip
TO TFIE STATE ANO COUNTY TAX ASSESSOR.. -
q_. +~.~-~C1~ COIMITY. flOR10A:
i in thi Shia of fkxida that 1 am filing this day in aooordana.
- Thts b my dadaration of Domkila and Cititansh p _
and In oonformHy vvid~ 222. Sactia+ 22'2.17. fbrkla Shtutas.
9~a~S~ir~----- ---------------------. --~~! ~ 4r=eY ----
I was fonnarly • legal rasid.m of_----- taM - a•~a
- _-- • l~owwr, I haw changed my domkila
and 1 resided at----- ~~- ~- ~rY'.a~l-------------------
t of the State of Florida :znoa___~Sti~------------------daY of
to and am and haw bean a bona fide rasldan
19- ~~. and 1 reside at ____~QL~t2_~_~SL~_ ~L~ Ramat ---park
------------~aaenher ---__---- t~ ~ '~e®inole
.and this statement is to ba taken as my dadaration of citba~uhip, actwl lapal'residar+os and domidia_in tM Stab
of Florida. -
lt~ 1~n say p«N~NM +.a,, wd~ « ..w of p.v.ra « lwt~.w « e~WwwM1~K .r «.vb+-M~Mr M terwM da.kM..
ni.wd .r r.~hr M ~nr ra.w~ ~ d Mu.a, sea -
Entering-Myra Lynn Clark 1n the 9111 Grade of Public Schoml.
ref ~ -: ~ ~ ~-.: --
- . /fit ~~, -= ~ ., ' ~ ~ -
. ~~~~~~•
• $~
1961,lAN -2 AM 9: OS
• - ROGER POITRas, JERK
RT• LUCIE COU T1', F10RIOA
----------~prt,~i~~ --= -------~--_ -
1 FURTHER C@'TIFY the I will register M my lou! addr~se when /ht rapitttaflon books reopen, and aompiy wish
all other nsqukenw+~ of a lapel nsldant of ~ Stela. ~ .
1 R)RTHER CI~TiFy that j haw ra MteMion b rNurrr b my Former domldN. and 1 hstand b remain in__-~-
- -~.,~,L~.._1aiRilt----- -------- ~"~- Florida,
-- Itra: - Bobei. alark
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