HomeMy WebLinkAbout1961 ~"w~LE~31 Gi G~..1Q:iZ:~~:~ ~it~~ ~i~3 -
~r~,-ri~~: s~rn~c~, n~i~ c~ov~~r~~ ~r,~a nssi-:stioit, 236410 '
- ~~c.~--_cuu~~rY, rt.aitii~,~:
'll~is is n?y ~lrrlaratic~n c~f Uomirilr .~n~l Citirrn.hi~i in th~ St:~t~ of ~lorida th;it t,~m filinr this day in
accorda~n~c, :incl in canformity ~vith Scrtioii ~'".17, ~lurid:`Statutrs. `
I~Vi1S fUlllll'iIy 1 IC't',al resid~nt of ' ~ , ~-/~L~ - and I
- . (citr) (slate)
residcd at ' . Ilo~vcvcr, 1 ha~~c changcd my domicilc to
9 ~J- ~~~1 an~i~umttar)
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and am and have bccn a bona Cdc residcnt of thc State of ~lorida since day of
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1~ ~ , 19 7~.., and 1 resid~ at ~-Q-~-E-~~`""`~ ~
~ (~Ireel and NumbcY)
) l UL~ 1~ ~~i •~,c.-t , .~-,~~-L-~ County, Clorida,
(City) ~
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and this statemcnt is to be taken as my declaration of ciiizenship, actual irgal residence and domicite in the State `
of Clorida. ~
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(Insert hetc aoy pertincnt facts, sutl~ as wle of property cx huciness, or relinquishmcnt of employment al torme~ ~
domicile~ removal oi tamily to ne~v domicilr, purchase ot home, ete.) ~
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'n~-~-ti
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~~~.2~/ . illEO ?ND PECOROEO
fT.tUC1E COtlMTYfLL
ROCcF ~OITAI,S ~ ~
. ~ ~ ti~ERK CI~',CUIT COURT ~
' RECORO VE4`~~~0 ~
. ~ ~ ~ 40 ~'~t
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236410 3
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I FURT}IER CE1tT11=Y tlr~t I~vill rcrister at my local address whrn the registration books reopcn, and ~
comply with all other req«iremcnts of a Ie~~l resident of this State. ~
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I T'URTIiER CGRTI~Y tl~at 1 ha~•c no intcntion to rctiirn to my tormcr domicilc, and I intcnd to rcmain in z
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} 1~, ~ ~ fi" o~..,~.` c~_- b , County, ~
rlorida, pcrmancntly: (c~~r) • ~
, - Gt-C, k~ ~t-~ rL , _
.r ~
(Name) ~ ;
~ ' / cJ D \,,.~.~~y" _ . ~
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• _ (Addrcss) i
Sworn to acid ul}SrTit:~d bcforc mc thi~ day of
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~ A.D. 191~ ' ~
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Notary 1'u I• St~~ u( 1 I~~nJ~ al I_ar*r .
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My Commi..sion rxi~irrs - -2 - l6 - 73 . - -
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(Tu Ix c~eculyd in Jupl~aal~• and unpiu~l tJ.•J ~~i1h l'Ir~k ('~rrud Coutl. anJ Juplw•alr wilh Ta~? Mscw~rl ;
~ ~ oo~ 2U5 ~~E 1~fi1 `
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