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This b my dedaratbn of Domicile and p in the StaN of HorkM that i am fUMp thM day In aooordana and
In conformity with qupbr Z~2, Section 2.17, Hetide Stelulas. _-- ° ~.
1 was fonr~erly a legal reskiarif of-__ C~ _._..~__-- -------------- -____-~• ~• ~ _--
and I resided at _-- ~ •_ Shore Rd. _ --------------------------. Fbvwver, 1 haw clurged my iomidle
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~to and am and haw bean a bona fide resident of the Stab of Honda sins-__-_ 1~ _______-_______-- day of
-,A~~-------- ---, t9_ 61, and l nslcle at __ 7a0 P='isa Vista -----
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----1~._.PSERGE._-- ~ gT. LUCIE --____-- Coumy, Honda,
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and this statement is to be taken as my dsdaration of dtizanship, actual Ipal residence and domkile In the Stab of Honda.
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101623
~FlEO Atp R BOOK
1961JAN -5 PM I: 43
ROGER POITRAS, CLERK
tT. LUCIE COUyTY. FLORIDA/~~i~
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I FURTHER CERTIFY that I will register at my loal address when the registration books reopen, end comply with all
other requirements of a legal resident of this State. -
I FURTHER CERTIFY that 1 have no intention to return to my former domieile, and I intend to remain in
`----FT._~.~~~$----------- --------- $T. LUCIE-------------- c«,MY, Fkxide,
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Sw~~-JP.~3ub~cn'bsd before me this----~~___-- --___day of _-- JAItUAR?---------------------, 19_ Z___
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ER IT CLERK CI IT COURT Nota Public
BY - -- -- -------------------- D.C. My Commission expires--------------------------
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