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1~0 Tf~ 8TATE ANO COtNTY TAX ~~ ~ - ~ t : ~ ~'~~ ti ~ ~' ,~ ~ ~":
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~. Thb b my dad~rMbn O~ OOmidlo era! in ~ Af'll4tld~ ~ I am fllMtp'~~~ 111 ..1V
M conformth wNh -ems: 3~0~1--~+~~`!I~t' .~ ... .: ,~ ..: ; .-
I wa inrmwll- ~ legal r«Idant af~..~l.- - ___.~~It-,---~
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Nld I raalded it __~.._.._.... d'~ ~d'~AL~~~.-...:_..~..r...--+r.._-....-.-a t ~~
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. to snd am and have been a bona #ide ra~idetM of the SfaN of. Fiorida'einoa_..~--X43.---- --------- ~f- of
-----------~_~lS~.!lber - -_ -- ------. 19_-~-+ and I ratda ~t r _ ~••~ _~
--- ~ ' • _ Port '~. Lt~oi~
--------- Fort ~P~src~ ~ ~ 8t Le+~ ~ - -=-- - fir, porta+,_
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and this statrrnent Is to be taken as my dedanNon of dtiaet~hip, actual legal rasidertoe and don^kila in the State of Florida.
p~ 1~ +wr v«+~-r tact. «Kh r eta wf popaill ar or ~MnquUMn~nl al ww M tenww raaielle,
nn~ovd of ~f- b naMr doisldla. pwelMaa et howM- ~1 ~ 4
gstabliah-RosideaaF
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it06ER POITRAS€`e 10A
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1 FURTHER CERTIFY that i will nepister at my local address when fhe npiatratior~ books reopen, and comply with ali
other requkements of a le~l• resident of this State. .
I FURTHER CERTIFY that I haw no iNent~os b rNum to my former domidlo. a~ I intend to remain in
--- ,r'~`~~~iaM __-__---'-_. ---__----• -----~ fM-~YM~Y~M~---__-----_ = r -- i`Ounty, Florida,
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'en fiend tubsaibed before me this_~__=3$Zh--- -----daY ~ ----J______________~_~_, 19 _
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ROGER POITR/1S, CL~ER[~K tlRQll
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try M aarwM~ b i~i1wM ari aal~lad ~ wM ~ C1nab Cwir4, w!: ~a ~rM Tar Aoaclacl
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