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po>rlarotion of ~4!'~bi ~~~~hlp
TO THE STATE ANd O~ITY TAX /ice,
1'WRIW1+ .
Thla h my dedaration of pomidlt and CNI>oaruhip M the State of Honda that 1 am filing thts day in aooordanoe and
- in conformity with Chapter Z24, Section Z~.17, Honda .Statutes.. •
fonnarty kipai resident of_ _$?cs_~~d4~~!~'u!- -----=- _.._ Ohio-------------
1 was a ---- ~ -------- -~ qw~
and 1 resided at ________--1~-$9ii~l--~~~------- -------. Flowaver, i haw charged my domidle
~••r .~ taws
to and am end haw been a bona fWe resident of the Sfata of Honda sinoe___~--------------------- day of
--------~~-~~~,~.~ _~__ 19~, and I nteide at _~~_ ~A A_v_enus ------
----=-=----Fs:~x3.~g~~lorid+~ ~, ~ St. Lnaie __~_~~ County, Florida.
tan+- .
and this ststemanf into ba taken as my declaration of dtiaanship, actual Ipal nsideno~ and domidl~ in tM State of Honda.
. q~wrt hre asy P~~~ fae4, wd~ M MM d pepKh- M Mme, a nIM~~MMMr d M ior~.r dowkJM,
,«wwal of t~nM~- re new dswlclM. wrdw. et t~R ~1eJ -
E~iLerina ,Dean Rayl~ond auland in the 2nd Srade of
Puiblic 5chool.~ ~ ~ ,... ,:;
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ROGER POlTRAS
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I FIJRTMER CERTIFY that 1 will rapishr at my local ardresa when, the rplgration books rtopen, and comply with ali
- other raqufnn»Ms of a legal resident' d thb Stan. ~' -
I FVRTF#R CERTIFY that i hew no Irw~mlon td rafvm .b tYty fonrMr dt, and 1 irNand to nrnaM to
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