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Thb Is my dadaratbn of Oon+leih acid C~1is~kip in 11N,.SMN A~' Hotlda 16at't ~~ } N~ drs- In aoootdMe~glrf ~ ,
and in b wide Chi ~: >hdion 2.17, 1'loeidr ljNtuN~. -
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1 was lonnarlp a i.pal n~idai+t of__-- Fhlladsl~ila .~-- -=~--r--:-~----~ . Pena, _; •-
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and I nsWad at__~'L~,~__Y_10~1L_$f----~------- --- -- -~ Ho+~rrt. I~~I+aw-ck~eW~d m~- ~domidi~
paw ~ sfi.i.~t . - _ - -
band am and haw 6a~n s bona ftdt rwidant of thi ~ of Rorids stna~_..f,.:12th
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_-- ~u~uet __________ _______ •i~_ 61 .. and 1 nnitN at ~t _ 2 Boz ..2998_ ?t s, •slton8d
fats - -- ------------------ ~Y• Fbrida,
and thb statamant b b ba taken at my dadarsdton of dtiaNnhip, actual Ipd ~wldanoa and domidl~ M dw Sbh ,
of Fkxida.
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lIM«t bn Mf- Me1Miw faa~, wide M rN ~f rely a fMO~~ r nM~~Mwwt ~t ~Yr~t M iMwr i~NeM~ii,
nw~d d iwM~r M swr iwMi~, pMd~w~ d Mme, Mel - '
Betabliahing reeidenoy
101465
IN
1962 JAN -2 qM 10: S6 .
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I FURTHER CERTIFY that I "will npiahr at mlr kxal address when the npbtration books nopan, and ooniply wHh
all other rt~ulran~ants of a Ipal raidant of thb Shia.
I FURTHER Ct~tTIFY that I haw no iMantbn b n~hxn b my format dorNdh, and t Mtand b remain k1____--
--------~A~-~~:9F4~--------------------- ------1~•7~lOu--------------- Counts. FlorWa,
permanently. .,
.~ .:~ c uls4 d Hoehn
Sworn b and'subscribed before me thb_ _ `, ~iJ:"~•.•`~ ~ ''••,V ~---J~lui~1------..--------- Iq- ~Z
Y -~ --
POITRAS, CIRCUR ~ :? ~ ~ ~ '~~ p~k
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Ih M ~waM/ r ~rM a~i '~l.p,~M t:~sA, ~aM I~b nMi tra Ate!
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- oroo. rr. ~.tRet - ter, ~ . ~ :~ -
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