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thr la mfr daclaratlon as oa~~fl..nd AIM' M fb: ita~a of aa.w. iGat ~ «~ IIWp tt~ia ~l- M aattatdanea .wd
~ qty wiN~ CAaptat m sactbn m.~~-~ lfotWa itaft~a.
1 was fonM.ly • Ipr rasldanl d
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and 1 nakMd of ~~..~~..---_ Nowawr i haw dwipad m'i- donM~lia
~Straa~ and Nutnbacy
band any and Mw ba~a- * bona fide ~ of tha Slpa of fbrida aina
~~'= 14~`... and t ~asida st
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dw ai
cwt and Nt~te~
l~OiT lflAC>>Z l~Alrf11 f-fKd1601MtY, ltiOSQA ,,,,_ __
and thb atatanwM is b ba taken as my dadararion d dMtamlMp~ actuM ~ t~sidw~oa and domicii~ in the State d HotMM.
QnieA hen any pwtinant facts. ouch w solo of property or buaM+ass. a ta4twfuishnwtt of amploynwnt
at forenar dondeilt-, ramo~val d fan+ily b now domidla~, purrlwasa d hoew. ate.1
~ •CHIIa D1 R18?.IO SOSOOL
~sasa-sti s. s'~so~ear t~ sral
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1963 0,~ 27 AM 10: 2t
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I f~lRTlff3 Cf3'i~1f that i will rapistar a1 my bal address when the registration books nopan, and comply with
aN o~a- nquiran+arwa d a 1a4s1 resident d this Stara.
1 F1lRTMHt C~T1Flf that 1 haw ra inNntion b tMwn b ~1- fornw domWN, and 1 M+tand b r+amaM~ in FCIRI
lam, SAItrT ttJC'lE COUNiYo F~RtW-, p~nnanarwir• ~ . \ 1 R ~l.J `" ..~ ~~ __.
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`~ ~ r` .: +~ Ada+Ml
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~ bw~a~tbafnd; p~bavib.d i~afa. m. thi. el.~- d 19
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~OIR1 ~Nofary- hibik
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OTC. IMl- ConnMatbn acpkw
R. M auawbd in iiwi~ ..d rty~..1 fad wfll, f~tt Lyt..b ~ and d.~l.r. wbU is A~wrJ