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Dec~arati ~~ ~ red Cih~ten p
TO THE STATE AND COUNTY TAX /I,~ESSOR,
st _ T~Ci e" C'OUN'TY. RORIDA:
This is my dadaratbn of Oomidle and~Citinar-ship in the State of Florida that I am filing thb day in aooordanos,
and in aonformlb with ChaptK ~~~ Section Z2Z.17, Florida Statufu. .
---------• ---Ill ~i.a.------
1 wu formerly a Ipal resident of_--p~3•~.p~tk----------- ~t"_
• --____-. However. I Mw dhanped my domidle
and 1 resided at_____~•~-~~ ~~~-------------
----------daY of
to and am and Mw been a bona fide resident of tM State of Florida sinoe___ 16th --____--
June at __1sOQ_ Populate _- Ri_v_e~ Pa~`~___-- _
-----------------. 19_61 _, and 1 reside -- A~ ;~ r+~~.~e«l
3~._?+~8-------------- County, Floc .
Fort Piep~d-------------------------• --------
------------ :. toM
'and this stalemeM is to be taken u my declaration of citiaanship, adwl lpal ruidenoa and domkile in the State
of Honda.
pawn Mn aws• Mr~MwM Iwti wd~ ~ wM of NewtY a ~ww r w~rw«M ~ ~"~"""~ M tMwM do/~1eIM.. .
w~erd ~t tM~f N /~wr i~wieM~, PM~M ~ Mww Mal ~ ~ s .~ ~ ' .~ ~'
Eatabliah fteaidtec-cy
. .
f ~.
.'' ::~ ~ '' ~ 't
~y.C~.~`arrs •:
Ate RECOR~D~~
FEED BOOK
1962 JIW -2 AM 10:38
it.°inclE COUNTY f~lOR~io~-
-~,~
~ ~ -addna when tM n•~istration books reopen, «+d ~Y with
1 FURTl~t CERTIFY that 1 wiq register - my .
all ocher requken+nnls of • lopsl n!idsY~t of d+ts Stall ~
1 FURTHER CERTIFY /tell 1 hew no intetMlo~ t4 return. to my forn+er domidle..and 1 intend to rerrwM {n__----
. - Florida
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Bar~ L: Nes~iver Perk
. -~ Popullar~~ --. ---------------
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.. p4 b ssr~ 1• ~~ sr4+t wM~~.~hr+illt~.~~ ~~ ~ ~MrF.rlfrJt~w Ar~sM•~l ;
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