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t This Is my d~d+~ntbn of Oomidl~ a~d ~P in th~ StaN of Ho~da ~hat I am Hiinq N~is day in a~oord~t~a and
; i~ aon~an+ii~? with qwplw Z?'2. S~cfbn ~2~.17, Florida Statu~a.
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- 1 ws~ forn~ly a Ip~l tNid~N of ~
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and 1~WM! d ~ C11tp3n ~d 1iow~vt~r ! hevf tiw~.~;.: n~, ,+~~~:~:ula ~
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b and Mn and hsw bNn a bo~ Nd~ nddim Qf tiw Stat~ of Florida stno~ ~ '~r
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potober 96~ S. ?~dian RL~er Dt~i~s
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~ l~ORT MtRq, ~AMIT LUC~ GOIiN~Y. ~A ~ -
l a~d this stai~rr~M is t~o b~ tak~n as my deduatbn of dtibnship, adwl Ip~l raid~~a and domfdl~ 1n 1M ShN af Horidi.
p~t h~n any psrtin~t facts, wch as al~ of prop~rt~? ot bu~nas. or niinquishm~nt of ~n~iq?n~n~
at formK domidl~, r~rwval of family to nsw domicil~, purdu~ of ha+n~. Nc.)
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~ RJRTHER ~ERTiFY 11fif ~ Mli~~
F ali a~hK ~i~r~+b of a Ipal rssid~nt of this State.
~ I RJRTHER GERTIFlf th~t i hav~e no lntention to ntum to my formsr dankik, and 1 iM~d to nm~In in fORT
` ~ PIERCE, SAINT LUCiE COUNTY, FLORIO~?. PsrmsnsntlY• . ~
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