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~uiy fan~sr I~p~l rqid~no~ w~s in tta City of ~ ~7~
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- (No f~irth~r stat~nNnt ~s r+~quirod Ho~wrv~er. ~ You wish, Y~ou m~y i~s~rt any p~rtina?t facts
~ such u sal~ of pn,~p~rty or bwtn~ss or relinQuishment ot a+mployment at forn~er domidw, removal
~ af family to n~w doenidM~ P~~Iws ot home~ _
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~ i FURTHER CERTiFY 1 wiU ~omphr with aN requtroments oi a i~al residsnt of this St~ta 1
i understt~d th~n is ~ passtty tor P~~~~ll: P~Iury la ~ Febryr and is punishabl~ by incaratiai In th~
! s~. oe~~n«~t a coR.~cro~s.
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~ . . . ROGER P:.•t~,l;*~~~ Y. F~~
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~ Notary Public~ State of.
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