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_ OBCLAMTIqi 01~ Odtt1C1L8 /N~D CIT12&i8lllP t~ ~
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~ TO 7HB STA'1~ AND OOIM~tlY 11SStiS~Oit.
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` 3T NICIB COt~~1Y. ELORIQA:
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~ tLia is d~slasatia~ oi Da~icile aad Citis~asAip ia t1?~ Stat~ oi Florida th~t I
a~ tiliaj this d~? ia accordiact. an~d fA cvato=sitr Mith S~ctio~ 22Z.17. Flosidr ~itatus~s.
: I Mas ~os~rly a le`al r~sidait of Nw York City, Nw York sad I resid~d at 31-~
~d 8trMt. J~cksao Hei~hu. Nw York I1s70. Howwr. I haw clunt~d daaicil• to
a4d hav~ bNa • boaa ffd~ r~sid~?t of th• Stat~ ot Florida sinc~ lhrch 1965, aad I r~sid~
at PQrt St Luci~. St Lucit Cou~tr, !~larfda. and this statwrot is to be tak~a as ~q?
drelar~tio~ oi citis~aship, actwl 1~~1 r~sida~ce and do¦~icile iA ths Stat~ of Florida.
I a~ ~ car~er offic~r ia Lh~ tAait~d Stata Ar~? preseat~r s~rviaj at Port Ilc~rsoa. ~
G~or~ia. I haw purchased ral ~stat~ at Port St Luci~, Florida. 1 sball s~sist~s to
v~ot~ fa tM St~t~ oi Florida wAsa I a~ elisible.
I FUCttiEit C8R7'ti~Y that 1 ri 11 re~ister at locsl address vh~o th~ re~istr~t~oo
boolcs r~op~a aod ca~plr pith ~11 oth~r r~uir~at.s of a le~al r~sid~nt of this Stats.
1 RIIR'MB~ CBItTIFY tbat i haw ao i~Lsntioa to retwrn to q fosMS doi~icila, aad I
~lnts~ to in Port St t~cie, St Luci• Ca~tr. Florida, p~rs~ntlr.
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