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~ro~c~ex oF~ cu~curroou~r,
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S1ts b my deetaeae~on ot Domte~. and Cie~enabip ch. Sac. ot F~oeida ~ t aea fiuna ~bts d.~r te aoooedaac.. and b
~emity wich Ssccion 2~.i7. Florida Stacuc~s. .
Zva~ ! e~l a kpl casideat o~ ~~a c~~C> i// e ~ d - aad t
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rrd~d at G O~ /~v~act~e~v t- - Ho~r~t. I haw ebaAssd my domieil~ to
I~bwt W N~l~rf ~y
a~d am aad h~va be~s a boaa Gd~ e+nid~at oI tbe Stats o[ Florida aiae~ ---2- d aay at
19~ aad I c~sid~ it =h a ~~~ma- r '
. tstr.~t.d Nr.e.r1
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° aed t~ts stateaaeat b to be takea as mp deetarstioo ot eitizewldp. aetual kaal reaidene~ aed doaiic~ ia t!~ Stato ot Florida.
IP i0R TME !'URPOSE Of ENROL~ING I< <OR NOMESTEA~ ~URPOSES~
CNI~OREN IN SCHOO~~ P~EASE STATE ?LtASE CHECKS ~
TMLIR NAMES.
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UCIE COUMTY flA.
~ ROCER POltRAS '
CLERK CtRCU1T COURT ~ ~
• c: ~ nn~ YE ~~FIEO.~.,,.,~,,,.
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FEB ~l 2 23 1
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3940~'~'9
I FURTHER CERTIF`Y that I w~l rtgittet at mr loeal addr~sa wrhea tbe registratiat baoka reopea, and complr writh all
eR6er requiremeats ot a kgaP cesident ot tAis State.
; I FURTHEZ CEBTIFY that I Aave ao iateation to retnrn w m~ forme~ daniule. and I tntend to remain in
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~ ROGER P01 TRAS. CI.ERK OF C IRCUI T COl~2T
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~ ST, lUG 1 E COUNTY, f lOR 1 UA ~
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= 60QK 2~~r PAGE 340
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• AGO Forw 71 ~
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