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- i ~ - . ~ ' / • ' _ \ - Oral~u'attan o1 Domlafl~ and CltutMShip - r0 T~ STATE Mt0 COUNTif TAX ASSE~ypR. . ' . n, ux~ coWVTr. aoRicw: ~ Thb b m~r d~d~r~tion of Don+idl~ u~d CMi~hip tn th~ St~t~ of Flarida M~t ~ am fiii~q thb d~y M~ooon~~a ~nd M conformih? with CMptK ZZ~. S~etbn ~Z4.17. Horida S~tatula. ~ wss ~"E'R `S R o~ GC/!5 S • formKly a Ipal n~t~Nnt af I~ / ~l/ • KitY) . ' ~ a,d ~ r~te~d .r O ~t,~'"~ ..2 ~ 3 Elow+vK 1 h~v~ cfia~ip~d mY domWl~ : (S1~Nt and Phnr~b~?j ~ . b ane! am ~ h~w bMn a bona Nd~ raid~M of th~ Stat~ of Hortda sina ~ d~y o/ ~ ~ ~ ' ~C a~~ 19__._~3 and t raid~ at O T~ Z. ~ 3 ~ (St~~M and ; ~ORT l1~. fAM~lT tYC~ GOUNTY, RORlp~A . , u~d thls ttahrn~r~t b to b~ take~ u my dsduatlon of dti~nship. aetu~l Ipal r~sld~na and don~kil~ In th~ St~N of FOotid~. ; . . ~ pmKt h~n any psrti~t fads, wch as ai~ v# propKly or busln~ts, or nlir~quhhrn~nt of rrnplo~?m~a ~ ; at forrn~r domidl~, nmoyal of family to ~r domkit~. Purd~ast of homs. re.) , ~ 5 i A8~/SI~/~v~ !s'"'Sl~Lrv~~~ . ~ ~ ~ • ~ • ~ED qlUp R ~ - ~ ; ~ ~ r""~ a~ ~ _ .BOOK ~ o !9 ; ~ <<~*,'. - . R~c . 5 AM1Q 23 ~ ~i S~. lqC E CS trRAS• ~ ~ . _ . ~ ONTt'. fLORIDA . . - r? • .A f ~ ? . • ~ . ~ ``~~F~~~•`v ~ - - ; i RJRTI#R CERTIFY MNt I will , ~r ~ ` ~11 othK rsqW~r~nfs of a l~p~! r+aid~nt af tiiis Stat~. . ; i FURTHER t~RTiFY that 1 hsve n~ intentio~n b nturn b m~? tortr~ domWl~. and 1 kM~nd b ~wraM M fORT ~ j : PIERCE, 5/1iNT ttKtE COUNTY, flORIDA, perman~nHy. ~ a ; tY„ t , . . ; ~r ~ •.O~?* G~!?,a,~ ~ J : ,~~.,IY.,Li~ . ~ - - • f~s~ - ~ ~ ` . . . ~ ~ f M ~ ~ • ~f ' ~ ~ . I~l~ [lJ/~ C7"!L L- ; i':, - . . ~ • v - ~ ~~~~k~~~., - i ; - - di1? ~ ~ ~T' 19~ ; Seworn b and wb~vib~d b~fo~ nw d~i~ I ~ f _ ~ . ~ ~ ~eoo~e torn~?: ; ' ~OURt t . Notary pubik ~ ' ~~~~~.r~[.~ . M - o~C. IY?~r Gonwntssia+ .xptn~ ~ ~ ~ R~ M .o»a~i i~ ~e~1..MI «yi~11N.. ,rMl~ CM~k CMaiM CwA, .~i ~Ii.M. ~ ~35 . . .'A'''~~~ . . s . i ;