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~~ TO THE STAjE ~ CQ~NV~Y TNC,~-~s *~:: j ~ ~ . ~ _~~~
~,~: ~ , ! . CUCIE~COUNTY. ALA. -
~' Thb b my dsidaration of Ootnidle and QMsa ie the SpN d~ Aorlda Sthaf i ari tiNno thh day in aoaordMtoe: ~ :
~' and in aonfonNty wNh ChapNr 7th, SKibn'~.1T, florkla SNttttaa. ,
is - - _ _ ,
1 was fonrNrly. ~ Ipd realdent of~.________-__y___...________ __s~ _- . _.._-, __---_-____ .._-.~-__.
and i resided at--------=----------- --- -------------------____. Howwe(, 1 have chan0ad my dOmfdle .
pNwiN r./ MM.r.d
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to and am and haw been a bona ikl~ realderN of the. State of Notida stool------~--------',~G-------____day .,of
------,pM'1--------------------. '19_61_ and I nald~ of __`~~9 A. Oli~-ys,,yR~iv_er_ Pant --- -
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Fort Pieros ~ ~ 8t. Luo~.o
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and thb statement is to be taken as my dedaretion oaf dMaa~wldp, actwl bpai naidence and domkfle M th• State
of Honda.
pawn hn. MMI oorMmwf t~bK, wd~ a .!~ of ~eaMMY a. ~oi~w, a 1~1dIM~MM ~ Mplorwrr M IMw~r i~kM~,
nrwl 01 1owM~- a ww AwdelM, ~at~ ~ ito~, acl .
l[ailing 4ddreees
P.O.Boz 2102, Stuart, Florida .
ltr. d;ldrs Lindsay are insigrants to the IInxted 8tatee, having entered the
states on February 2, 1961
Their intentim ii to live in Foist Pieroe.
1~145~
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. IN ~ ~ REI~QROED
~962,)gjy -Z An is 23
sR~ UCIE COUNTI FLOC
RIOA
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1 FURTHER CERTIFY that I will rpister at my local address when the rpbtration books nopon, and comply wHh
all other nquiremenh of a legal nsklent ~ thb State.
t FURTHER CHtTIFY that I haw no Intention m rehxn to my former domkih, and 1 intend to twnain in______
taM
permanently.
Sworn to and wbsvibed before m• tTtis..2
8cg er Poitras, Ole~lt
--------------------------------
_ t~OGER PflLIRAS, CLERK CIRCUIT
By
-- - -------------~•- e-- - Cow+ty, Florida,
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OMw~
s 8obert Liadea~ _________________
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kT's, :~"+~ ":~~; - Notary Publk
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