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TO THE STATE MIO OO~JPITY TAX /1SS~3~. : --
_ $t • Ltte1~ eeunmr, R,pitlalls
Thb is my declaration of pomidle and gtip In the Sfate of Honda that I am fllinp thb day In aooordar-w and
in conformity with Charyter 2Z'2, Sectbn x'2.17. Florida SatiAea.
resident of_.._ Indiaatpp3,~i Ind. ----------
1 was. formerly • ipal ---_ _.---.-------~ - ------------• ------ A~•1
~$ __2102a.---- Howwar. I Mw changed nh- domidla
and 1 residid at ____----~2-- ~ ~~~ -- ~ --------•
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fide resident of the-Stag of Honda stns__.b>~,h.------__~__~--------- daY ~
to and am and haw been a bona pOTtwgt•LuC1e
-----------.?3tua~-----._._-- -._-._--:------. 1~1---• and I t~aide at --1~- Yuat---~~-Blsd
aw.a
Forti Pierce - 3t.Lucie w------ ~~. Honda.
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and thb statement into be taken as my declaration of dtianthlP• adwl ~ ratfdenoe end domidle in the StaN of Florida.
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I FUIlTt1E11 CERTIFIs" that 1 wlil rpiaterat my lotll.~~{,W~1aln ~ ~~ hooka raQpafy_ and comply with all ,
other regvirernon». of a ~ '~ ~ ` ' ~' ` ~ ~ _: ~ ' ~ ; -' ..
.I WRTHER C,,ERTiF1! ~ I haw,no Mie~tion !a n-Mxn_1!0_my fatrar ~• `~^d i MNrd.totnrnafn in .
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