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T ~ - Declarolion of Dom ci'~
TO THS STATE AND OOUNTY TAX A38Tt8801;,
3a~t_ t-~ 1~_OOUNTY. FLOjtIDA:
This i. mr declsratio~ of Domicile sad gtisenship in
sa;ordance, and in conio*mity with Chapter ?a:2, Section
I wss foccner~y a legal resident oi_______ Beading
and I ~ at 1315 North 9th _ Street
_ - i.~..~. ~.,... ,
to and am and have been a bona lade reaid~t o! the Sta
-____-- -ae~~naiuur _____~, 18.-9St., and i reside at._
Fcrt_P erne -. .~
-.
_ ia~,~
.- and this statement is to be taken as my de~;Lration of ~
the State o! Florida.
(Ineart here aa~ yertfnen! fae4, such as ..l~e e~tyro v:cxx
forme: doaieile, remo.al ed t~ib .to new dan~eiN. Daru
Purchased a Trailor e8d living et
91161
Fri ED ~?,D RECD-~DED
'1' P _..% J •. 1
~ ,. ~ ~: ~R POITRA ~. `.t~.,,,
;,;. ~UCIE COUMZY, F~G. A
I FURTHER CERTIFY that I will re,~is`+~er st my
end comply with all other regniresneata of a legal resident
I FURTHER CERTIFY that I have m intsnttoa to r
~ Dort Pisrae
~Ab)
eerrnaaeatb.
Sworn to and wbacsibed bdas me this-- 4
dy. et
. ~ J~nwry A. D. 716.1....
e~ ~ ~=~
Pulii~ ~at• ~E Drys aR ~ ~ ~,
][fir Coo~a~isdoa espittia. -~~ut . l~ s ~ l~ b*
;. ----
tr.D..s.eawiaaM~.~as
.a.....ens oe, lf~ae cw. iNa.
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